Provider Demographics
NPI:1487653051
Name:PAPADAKOS, STYLIANOS P (MD)
Entity Type:Individual
Prefix:
First Name:STYLIANOS
Middle Name:P
Last Name:PAPADAKOS
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 1:44-01 FRANCIS LEWIS BOULEVARD
Mailing Address - Street 2:SUITE L3A
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3002
Mailing Address - Country:US
Mailing Address - Phone:718-423-3355
Mailing Address - Fax:718-423-3721
Practice Address - Street 1:44-01 FRANCIS LEWIS BOULEVARD
Practice Address - Street 2:SUITE L3A
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3002
Practice Address - Country:US
Practice Address - Phone:718-423-3355
Practice Address - Fax:718-423-3721
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204072207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01851629Medicaid
NYG400088704Medicare PIN
NY01851629Medicaid
NY01851629Medicaid