Provider Demographics
NPI:1922042035
Name:SOUMAKIS, SARANTIS ANASTASIOS (MD)
Entity Type:Individual
Prefix:DR
First Name:SARANTIS
Middle Name:ANASTASIOS
Last Name:SOUMAKIS
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 1:125 WORTH STREET
Mailing Address - Street 2:BOX 45 RM 901 NYCDOH DIVISION OF DISEASE CONTROL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4006
Mailing Address - Country:US
Mailing Address - Phone:212-442-8468
Mailing Address - Fax:212-758-4734
Practice Address - Street 1:1309 FULTON AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:718-579-4157
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1841761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0105AWMedicare ID - Type UnspecifiedGHI
93S581Medicare ID - Type UnspecifiedEMPIRE
0105AXMedicare ID - Type UnspecifiedGHI
H89731Medicare UPIN