Provider Demographics
NPI:1467621391
Name:DEMETRIOS ECONOPOULY, DPM PC
Entity Type:Organization
Organization Name:DEMETRIOS ECONOPOULY, DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:S
Authorized Official - Last Name:ECONOPOULY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-863-5383
Mailing Address - Street 1:1906 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2013
Mailing Address - Country:US
Mailing Address - Phone:201-863-5383
Mailing Address - Fax:201-863-3055
Practice Address - Street 1:1906 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2013
Practice Address - Country:US
Practice Address - Phone:201-863-5383
Practice Address - Fax:201-863-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00208800213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU33816Medicare UPIN
NJ5503510001Medicare NSC
NJ139852Medicare PIN