Provider Demographics
NPI:1467501163
Name:PHILIPPOU, SOTERIOS C (MD)
Entity Type:Individual
Prefix:
First Name:SOTERIOS
Middle Name:C
Last Name:PHILIPPOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1529
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-7529
Mailing Address - Country:US
Mailing Address - Phone:516-629-2484
Mailing Address - Fax:516-629-2027
Practice Address - Street 1:100 PORT WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1353
Practice Address - Country:US
Practice Address - Phone:516-629-2484
Practice Address - Fax:516-629-2027
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130214208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00716234Medicaid
NY00716234Medicaid
NYD91645Medicare UPIN