Provider Demographics
NPI:1609393131
Name:STAMBOULIS, GEORGE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:STAMBOULIS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 32ND ST STE 1002D
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1139
Mailing Address - Country:US
Mailing Address - Phone:718-734-2373
Mailing Address - Fax:212-379-2123
Practice Address - Street 1:2408 32ND ST STE 1002D
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1139
Practice Address - Country:US
Practice Address - Phone:718-734-2373
Practice Address - Fax:718-734-2372
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2021-06-08
Deactivation Date:2018-12-26
Deactivation Code:
Reactivation Date:2019-01-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist