Provider Demographics
NPI:1750561312
Name:SKOUFIS, MARIA
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:SKOUFIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19606 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1334
Mailing Address - Country:US
Mailing Address - Phone:718-229-2021
Mailing Address - Fax:
Practice Address - Street 1:1923 UTOPIA PKWY
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-4131
Practice Address - Country:US
Practice Address - Phone:718-767-4854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-11
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01508772Medicaid