Provider Demographics
NPI:1851601728
Name:O. GOUSSIS M.D. PC
Entity Type:Organization
Organization Name:O. GOUSSIS M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:FRIXOS
Authorized Official - Middle Name:O
Authorized Official - Last Name:GOUSSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-773-6301
Mailing Address - Street 1:1010 NORTHERN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5306
Mailing Address - Country:US
Mailing Address - Phone:516-773-6301
Mailing Address - Fax:516-773-6120
Practice Address - Street 1:1010 NORTHERN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5306
Practice Address - Country:US
Practice Address - Phone:516-773-6301
Practice Address - Fax:516-773-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144663207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty