Provider Demographics
NPI:1962835256
Name:FOTIOU, VICKY
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:FOTIOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 MELBA ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5338
Mailing Address - Country:US
Mailing Address - Phone:718-524-1404
Mailing Address - Fax:
Practice Address - Street 1:365 MELBA ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5338
Practice Address - Country:US
Practice Address - Phone:718-524-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist