Provider Demographics
NPI:1497358709
Name:TSIAMTSIOURIS, JIM
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:TSIAMTSIOURIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CHANDLER DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5504
Mailing Address - Country:US
Mailing Address - Phone:201-240-1384
Mailing Address - Fax:
Practice Address - Street 1:30 CHANDLER DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5504
Practice Address - Country:US
Practice Address - Phone:201-240-1384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00390700235Z00000X
NJ235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist