Provider Demographics
NPI:1881049609
Name:NIKITA, MARIOS
Entity type:Individual
Prefix:
First Name:MARIOS
Middle Name:
Last Name:NIKITA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 33RD ST
Mailing Address - Street 2:1F
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1464
Mailing Address - Country:US
Mailing Address - Phone:917-225-1319
Mailing Address - Fax:
Practice Address - Street 1:3045 33RD ST
Practice Address - Street 2:1F
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1464
Practice Address - Country:US
Practice Address - Phone:917-225-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist