Provider Demographics
NPI:1720376585
Name:MARKOPOULOS, PHYLLIS (LAC)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:MARKOPOULOS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 WEST ST
Mailing Address - Street 2:#2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-1502
Mailing Address - Country:US
Mailing Address - Phone:917-716-3127
Mailing Address - Fax:
Practice Address - Street 1:154 WEST ST
Practice Address - Street 2:#2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-1502
Practice Address - Country:US
Practice Address - Phone:917-716-3127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004597-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist