Provider Demographics
NPI:1134213911
Name:TSOUROUNAKIS, EMANUEL N (DC)
Entity type:Individual
Prefix:
First Name:EMANUEL
Middle Name:N
Last Name:TSOUROUNAKIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 31 QUEENS BOULEVARD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-507-5581
Mailing Address - Fax:718-507-5075
Practice Address - Street 1:91 31 QUEENS BOULEVARD
Practice Address - Street 2:SUITE 304
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-507-5581
Practice Address - Fax:718-507-5075
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02220006Medicaid
NY75523Medicare ID - Type Unspecified
NY02220006Medicaid