Provider Demographics
NPI:1972665206
Name:JOSIFIDIS, HARRY T
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:T
Last Name:JOSIFIDIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 47 CRESCENT STREET
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11102
Mailing Address - Country:US
Mailing Address - Phone:718-728-5529
Mailing Address - Fax:718-728-5586
Practice Address - Street 1:27 47 CRESCENT STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11102
Practice Address - Country:US
Practice Address - Phone:718-728-5529
Practice Address - Fax:718-728-5586
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166922208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01463616Medicaid
NY172919OtherWELLCARE
NYN52982OtherOXFORD
NYHJ076D4710OtherB CROSS
NY43890AMedicare ID - Type Unspecified
NYHJ076D4710OtherB CROSS