Provider Demographics
NPI:1801834734
Name:KOSTOPOULOS, DIMITRIOS (PT, PHD, DSC, ECS)
Entity Type:Individual
Prefix:DR
First Name:DIMITRIOS
Middle Name:
Last Name:KOSTOPOULOS
Suffix:
Gender:M
Credentials:PT, PHD, DSC, ECS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2561
Mailing Address - Country:US
Mailing Address - Phone:718-707-6970
Mailing Address - Fax:718-707-6977
Practice Address - Street 1:3244 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2561
Practice Address - Country:US
Practice Address - Phone:718-707-6970
Practice Address - Fax:718-707-6977
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11118225100000X
NY011188-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06326GMedicare PIN
NYQ73612Medicare PIN
NY06322GMedicare PIN
NYA400004025Medicare PIN
NYG400000607Medicare PIN