Provider Demographics
NPI:1518035211
Name:DR. ELIAS TZANIDES PHYSICIAN P.C.
Entity Type:Organization
Organization Name:DR. ELIAS TZANIDES PHYSICIAN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:TZANIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-745-1234
Mailing Address - Street 1:8407 FORT HAMILTON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-745-1234
Mailing Address - Fax:718-745-4768
Practice Address - Street 1:8407 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4805
Practice Address - Country:US
Practice Address - Phone:718-745-1234
Practice Address - Fax:718-745-4768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01357955Medicaid
NY01357955Medicaid
NY73K691Medicare ID - Type Unspecified