Provider Demographics
NPI:1487687646
Name:DIMITRAKIS, TSAMBIKOS ANASTASIOU (PT)
Entity Type:Individual
Prefix:
First Name:TSAMBIKOS
Middle Name:ANASTASIOU
Last Name:DIMITRAKIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SUN VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932
Mailing Address - Country:US
Mailing Address - Phone:973-735-8553
Mailing Address - Fax:
Practice Address - Street 1:405 NORTHFIELD AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-325-7212
Practice Address - Fax:973-325-7214
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00442100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1487687646OtherNPI