Provider Demographics
NPI:1821356908
Name:KIM TSIRIGOTIS
Entity Type:Organization
Organization Name:KIM TSIRIGOTIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TSIRIGOTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-581-1882
Mailing Address - Street 1:1 SPUR DR S
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-2333
Mailing Address - Country:US
Mailing Address - Phone:631-581-1882
Mailing Address - Fax:
Practice Address - Street 1:1 SPUR DR S
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-2333
Practice Address - Country:US
Practice Address - Phone:631-581-1882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01419378Medicaid