Provider Demographics
NPI:1790730026
Name:TSATSAS, MANOLIS THEODORE (MD)
Entity Type:Individual
Prefix:
First Name:MANOLIS
Middle Name:THEODORE
Last Name:TSATSAS
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:PO BOX 27842
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7842
Mailing Address - Country:US
Mailing Address - Phone:718-670-1651
Mailing Address - Fax:516-437-4167
Practice Address - Street 1:16303 HORACE HARDING EXPY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1449
Practice Address - Country:US
Practice Address - Phone:718-670-1170
Practice Address - Fax:516-437-4167
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203209207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01860159Medicaid
NYG73346Medicare UPIN
NY01610JMedicare ID - Type Unspecified
NY01860159Medicaid
NY00669Medicare PIN