Provider Demographics
NPI:1790855468
Name:SKOUNAKIS, ANDREAS (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREAS
Middle Name:
Last Name:SKOUNAKIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 CLIFTON AVE STE 1F
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3518
Mailing Address - Country:US
Mailing Address - Phone:973-779-2466
Mailing Address - Fax:973-779-4943
Practice Address - Street 1:1011 CLIFTON AVE STE 1F
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3518
Practice Address - Country:US
Practice Address - Phone:973-779-2466
Practice Address - Fax:973-779-4943
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC006118111N00000X
NJ38MC00611800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
084350Medicare PIN