Provider Demographics
NPI:1467536011
Name:TWILIGHT MEDICAL CLINICAL SERVICES PC
Entity Type:Organization
Organization Name:TWILIGHT MEDICAL CLINICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANOUKAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:848-702-3050
Mailing Address - Street 1:16 ZIEGERT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-1160
Mailing Address - Country:US
Mailing Address - Phone:732-613-0152
Mailing Address - Fax:
Practice Address - Street 1:64 NAGLE AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1406
Practice Address - Country:US
Practice Address - Phone:848-702-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02058717Medicaid
NYH12071Medicare UPIN
NYWET731Medicare ID - Type UnspecifiedGROUP NUMBER
NY17V271Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER