Provider Demographics
NPI:1932131075
Name:PYRSOPOULOS, NIKOLAOS T (MD,PHD,MBA)
Entity Type:Individual
Prefix:
First Name:NIKOLAOS
Middle Name:T
Last Name:PYRSOPOULOS
Suffix:
Gender:M
Credentials:MD,PHD,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BERGEN ST
Mailing Address - Street 2:STE 2100 DIVISION OF GASTROENTEROLOGY
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2425
Mailing Address - Country:US
Mailing Address - Phone:973-972-5252
Mailing Address - Fax:
Practice Address - Street 1:90 BERGEN ST
Practice Address - Street 2:STE 2100 DIVISION OF GASTROENTEROLOGY
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09274800207RT0003X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2730006-00Medicaid
16448Medicare ID - Type Unspecified
FL2730006-00Medicaid