Provider Demographics
NPI:1215140017
Name:TSIROGIANNIS, GEORGE (DPM)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:TSIROGIANNIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 HUMBOLDT ST
Mailing Address - Street 2:OFFICE
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3256
Mailing Address - Country:US
Mailing Address - Phone:201-875-5310
Mailing Address - Fax:201-430-2422
Practice Address - Street 1:765 HUMBOLDT ST
Practice Address - Street 2:OFFICE
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3256
Practice Address - Country:US
Practice Address - Phone:201-875-5310
Practice Address - Fax:201-430-2422
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00297000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6595100001Medicare NSC
NJ187434Medicare PIN