Provider Demographics
NPI:1952508038
Name:GEORGAKIS, GEORGIOS V (MD, PH D)
Entity Type:Individual
Prefix:
First Name:GEORGIOS
Middle Name:V
Last Name:GEORGAKIS
Suffix:
Gender:M
Credentials:MD, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HEALTH SCIENCES TOWER LEVEL 18, ROOM 065
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8191
Mailing Address - Country:US
Mailing Address - Phone:631-444-8086
Mailing Address - Fax:631-444-7871
Practice Address - Street 1:LAUTERBUR DRIVE HOSPITAL PAVILION LEVEL 5W
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-3955
Practice Address - Country:US
Practice Address - Phone:631-444-8086
Practice Address - Fax:631-444-7971
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289527208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTAJ6217461N152OtherDEA JOHN DEMPSEY HOSPITAL
CTAS1559650G202OtherDEA ST FRANCIS HOSPITAL
CTAH1553571A240OtherHARTFORD HOSPITAL DEA NUMBER
CTAN1580489K929OtherDEA CCMC