Provider Demographics
NPI:1558329730
Name:VALSAMIS, AGELIKI S (DO)
Entity Type:Individual
Prefix:DR
First Name:AGELIKI
Middle Name:S
Last Name:VALSAMIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 NORTHERN BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5310
Mailing Address - Country:US
Mailing Address - Phone:516-708-2540
Mailing Address - Fax:516-708-2690
Practice Address - Street 1:865 NORTHERN BLVD STE 203
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5310
Practice Address - Country:US
Practice Address - Phone:516-708-2540
Practice Address - Fax:516-708-2690
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232359174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY232359OtherLICENSE NUMBER