Provider Demographics
NPI:1508827502
Name:VIENNAS, STELIOS (MD)
Entity Type:Individual
Prefix:DR
First Name:STELIOS
Middle Name:
Last Name:VIENNAS
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 1:3802 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3800
Mailing Address - Country:US
Mailing Address - Phone:718-728-5951
Mailing Address - Fax:718-728-1624
Practice Address - Street 1:3802 31ST AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3800
Practice Address - Country:US
Practice Address - Phone:718-728-5951
Practice Address - Fax:718-728-1624
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206085207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01888893Medicaid
NY03784Medicare PIN
NYG50297Medicare UPIN
NY01888893Medicaid