Provider Demographics
NPI:1629019005
Name:HARISIADIS, SPYROS ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:SPYROS
Middle Name:ALEXANDER
Last Name:HARISIADIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507
Mailing Address - Country:US
Mailing Address - Phone:914-666-2220
Mailing Address - Fax:914-666-2987
Practice Address - Street 1:52 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507
Practice Address - Country:US
Practice Address - Phone:914-666-2220
Practice Address - Fax:914-666-2987
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1515652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01919891Medicaid
E90154Medicare UPIN
NY0066145Medicare ID - Type Unspecified
NY675T71Medicare PIN
NY01919891Medicaid