Provider Demographics
NPI:1487825832
Name:LIVIU GEORGESCU MEDICAL PC
Entity Type:Organization
Organization Name:LIVIU GEORGESCU MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUDAROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-204-0414
Mailing Address - Street 1:6321 ALDERTON ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2824
Mailing Address - Country:US
Mailing Address - Phone:718-204-0414
Mailing Address - Fax:718-204-7470
Practice Address - Street 1:6321 ALDERTON ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2824
Practice Address - Country:US
Practice Address - Phone:718-204-0414
Practice Address - Fax:718-204-7470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196371174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01511059Medicaid
NY01511059Medicaid
NY=========OtherEIN-TIN
NYF87321Medicare UPIN