Provider Demographics
NPI:1457514598
Name:MOUSTAKAKIS, EMMANUEL NECTARIOS (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:NECTARIOS
Last Name:MOUSTAKAKIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:NEW YORK HOSPITAL QUEENS, CARDIAC CATH LAB
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-2516
Mailing Address - Fax:718-445-7473
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:NEW YORK HOSPITAL QUEENS, CARDIAC CATH LAB
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-2516
Practice Address - Fax:718-445-7473
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2023-03-14
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Provider Licenses
StateLicense IDTaxonomies
NY230890207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03111566Medicaid
NY03111566Medicaid
NYG400002355Medicare PIN