Provider Demographics
NPI:1669433983
Name:PAPADATOS, GERASIMOS (MD)
Entity type:Individual
Prefix:DR
First Name:GERASIMOS
Middle Name:
Last Name:PAPADATOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 19TH ST
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2604
Mailing Address - Country:US
Mailing Address - Phone:718-626-7500
Mailing Address - Fax:718-204-7005
Practice Address - Street 1:2310 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3396
Practice Address - Country:US
Practice Address - Phone:718-626-7500
Practice Address - Fax:718-204-7005
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142263174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist