Provider Demographics
NPI:1770169468
Name:MONTAUK MEDICAL TESTING SERVICES PC
Entity type:Organization
Organization Name:MONTAUK MEDICAL TESTING SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKOULIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-400-3999
Mailing Address - Street 1:1717 VETERANS MEMORIAL HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1532
Mailing Address - Country:US
Mailing Address - Phone:631-828-0720
Mailing Address - Fax:
Practice Address - Street 1:1717 VETERANS MEMORIAL HWY STE 2
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1532
Practice Address - Country:US
Practice Address - Phone:631-400-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty