Provider Demographics
NPI:1922496900
Name:KAPSALIS, NIKOLAOS (PA-C, MPAS)
Entity Type:Individual
Prefix:MR
First Name:NIKOLAOS
Middle Name:
Last Name:KAPSALIS
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2820
Mailing Address - Country:US
Mailing Address - Phone:631-265-4606
Mailing Address - Fax:631-265-4675
Practice Address - Street 1:321 E MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2820
Practice Address - Country:US
Practice Address - Phone:631-265-4606
Practice Address - Fax:631-265-4675
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018308363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant