Provider Demographics
NPI:1760589659
Name:PSIMOULIS, ANGELIKI (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANGELIKI
Middle Name:
Last Name:PSIMOULIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 82 36ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4705
Mailing Address - Country:US
Mailing Address - Phone:718-545-3070
Mailing Address - Fax:718-956-5813
Practice Address - Street 1:30 82 36ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4705
Practice Address - Country:US
Practice Address - Phone:718-545-3070
Practice Address - Fax:718-956-5813
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166874207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
9514642OtherGHI
P481050OtherOXFORD
57256Medicare ID - Type Unspecified
9514642OtherGHI