Provider Demographics
NPI:1740279124
Name:LOGOTHETIS, JAMES NICHOLAS (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:NICHOLAS
Last Name:LOGOTHETIS
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 1:283 APPLEGARTH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3737
Mailing Address - Country:US
Mailing Address - Phone:609-655-1046
Mailing Address - Fax:609-655-3830
Practice Address - Street 1:283 APPLEGARTH RD
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-3737
Practice Address - Country:US
Practice Address - Phone:609-655-1046
Practice Address - Fax:609-655-3830
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03545100207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC52545Medicare UPIN
NJ019201DACMedicare ID - Type Unspecified