Provider Demographics
NPI:1679657019
Name:STAVROPOULOS, STAVROS NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:STAVROS
Middle Name:NICHOLAS
Last Name:STAVROPOULOS
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 1:40 ACORN PONDS DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2818
Mailing Address - Country:US
Mailing Address - Phone:212-721-3029
Mailing Address - Fax:
Practice Address - Street 1:2750 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5720
Practice Address - Country:US
Practice Address - Phone:516-992-5626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205824207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02227961Medicaid
NYH59099Medicare UPIN
NY410N61Medicare ID - Type Unspecified