Provider Demographics
NPI:1609279272
Name:ACHIEVE MEDICAL HEALTHCARE PC
Entity Type:Organization
Organization Name:ACHIEVE MEDICAL HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMOS
Authorized Official - Middle Name:
Authorized Official - Last Name:KANAKOUDAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-824-1380
Mailing Address - Street 1:1 MONTAUK HWY STE B
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11977-1248
Mailing Address - Country:US
Mailing Address - Phone:631-369-4292
Mailing Address - Fax:631-443-4493
Practice Address - Street 1:10 OLD RIVERHEAD RD UNIT A
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-1460
Practice Address - Country:US
Practice Address - Phone:631-369-4292
Practice Address - Fax:631-443-4493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60257261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty