Provider Demographics
NPI:1457408163
Name:EMANUEL L. KOUROUPOS, M.D., P.C.
Entity Type:Organization
Organization Name:EMANUEL L. KOUROUPOS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOUROUPOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-204-1100
Mailing Address - Street 1:2747 CRESCENT ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3142
Mailing Address - Country:US
Mailing Address - Phone:718-204-1100
Mailing Address - Fax:718-204-2049
Practice Address - Street 1:2747 CRESCENT ST
Practice Address - Street 2:SUITE 206
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3142
Practice Address - Country:US
Practice Address - Phone:718-204-1100
Practice Address - Fax:718-204-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
872420OtherAETNA
28110POtherHIP
NY00869470Medicaid
NY34D462OtherBLUE CROSS BLUE SHIELD
NYDP282OtherOXFORD
NYA62323Medicare UPIN
NY00869470Medicaid