Provider Demographics
NPI:1396794228
Name:NEAMONITIS, THEODOSIOS (DPT)
Entity type:Individual
Prefix:DR
First Name:THEODOSIOS
Middle Name:
Last Name:NEAMONITIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3063 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3803
Mailing Address - Country:US
Mailing Address - Phone:718-932-1269
Mailing Address - Fax:718-932-0198
Practice Address - Street 1:3063 38TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3803
Practice Address - Country:US
Practice Address - Phone:718-932-1269
Practice Address - Fax:718-932-0198
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024817-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06675GMedicare ID - Type Unspecified
Q31245Medicare UPIN