Provider Demographics
NPI:1669450763
Name:YATRAKIS, GEORGE DEMETRIOS (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DEMETRIOS
Last Name:YATRAKIS
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 1:155 E 76TH ST
Mailing Address - Street 2:STE 1H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-737-4630
Mailing Address - Fax:212-879-4486
Practice Address - Street 1:155 E 76TH ST
Practice Address - Street 2:STE 1H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-737-4630
Practice Address - Fax:212-879-4486
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115949207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00214599Medicaid
NY910441Medicare PIN
NYB20056Medicare UPIN