Provider Demographics
NPI:1588803597
Name:MOUSSOUROS, CHRIS (R EP T, CNIM)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:MOUSSOUROS
Suffix:
Gender:M
Credentials:R EP T, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MAMARONECK AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1700
Mailing Address - Country:US
Mailing Address - Phone:914-682-9000
Mailing Address - Fax:914-682-9044
Practice Address - Street 1:360 MAMARONECK AVE FL 1
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1700
Practice Address - Country:US
Practice Address - Phone:914-682-9000
Practice Address - Fax:914-682-9044
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic