Provider Demographics
NPI:1891818431
Name:SOTIRIOS KASSAPIDIS M.D, P.C
Entity Type:Organization
Organization Name:SOTIRIOS KASSAPIDIS M.D, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOTIRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAPIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-278-6595
Mailing Address - Street 1:2231 33RD ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2402
Mailing Address - Country:US
Mailing Address - Phone:718-278-6595
Mailing Address - Fax:
Practice Address - Street 1:2231 33RD ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2402
Practice Address - Country:US
Practice Address - Phone:718-278-6595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01737640Medicaid
NY06111Medicare ID - Type Unspecified
NY01737640Medicaid