Provider Demographics
NPI:1821157058
Name:KYMISSIS, PAVLOS I (MD)
Entity Type:Individual
Prefix:DR
First Name:PAVLOS
Middle Name:I
Last Name:KYMISSIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:110 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1137
Mailing Address - Country:US
Mailing Address - Phone:516-365-7214
Mailing Address - Fax:516-365-7214
Practice Address - Street 1:7136 110TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4852
Practice Address - Country:US
Practice Address - Phone:718-544-8506
Practice Address - Fax:914-674-4572
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1288622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB87288Medicare UPIN
NY0033S128Medicare ID - Type Unspecified