Provider Demographics
NPI:1659013159
Name:EVGENIOU, IOANNIS
Entity Type:Individual
Prefix:
First Name:IOANNIS
Middle Name:
Last Name:EVGENIOU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WOODYCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1715
Mailing Address - Country:US
Mailing Address - Phone:631-278-3164
Mailing Address - Fax:
Practice Address - Street 1:210 WOODYCREST DR
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1715
Practice Address - Country:US
Practice Address - Phone:631-278-3164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician