Provider Demographics
NPI:1902842446
Name:VOUDOURIS, APOSTOLOS A (MD)
Entity Type:Individual
Prefix:
First Name:APOSTOLOS
Middle Name:A
Last Name:VOUDOURIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BROAD ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2629
Mailing Address - Country:US
Mailing Address - Phone:973-707-2916
Mailing Address - Fax:201-297-5596
Practice Address - Street 1:135 BROAD ST
Practice Address - Street 2:SUITE F
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2629
Practice Address - Country:US
Practice Address - Phone:973-707-2916
Practice Address - Fax:201-297-5596
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NJ25MA07313600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist