Provider Demographics
NPI:1013078732
Name:MEZITIS, SPYROS GE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SPYROS
Middle Name:GE
Last Name:MEZITIS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E 69TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5737
Mailing Address - Country:US
Mailing Address - Phone:212-288-6661
Mailing Address - Fax:
Practice Address - Street 1:220 E 69TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5737
Practice Address - Country:US
Practice Address - Phone:212-288-6661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203327207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG66785Medicare UPIN
NY793121Medicare ID - Type Unspecified