Provider Demographics
NPI:1770368078
Name:FILAJ-DIMITRIADIS, JARA
Entity type:Individual
Prefix:
First Name:JARA
Middle Name:
Last Name:FILAJ-DIMITRIADIS
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 1:2166 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3355
Mailing Address - Country:US
Mailing Address - Phone:917-617-7283
Mailing Address - Fax:
Practice Address - Street 1:404 E 91ST ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6807
Practice Address - Country:US
Practice Address - Phone:212-369-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist