| Theofanis Mitsinikos, Do, Pc | |
|
2500 Nesconset Hwy Bldg 3c Stony Brook NY 11790-2551 | |
| (631) 751-2400 | |
| (631) 751-8323 |
| Full Name | Theofanis Mitsinikos, Do, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2500 Nesconset Hwy Bldg 3c, Stony Brook, New York |
| Authorized Official Name and Position | Theofanis Mitsinikos (OWNER) |
| Authorized Official Contact | 6317512400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Theofanis Mitsinikos, Do, Pc 2500 Nesconset Hwy Bldg 3c Stony Brook NY 11790-2551 Ph: () - | Theofanis Mitsinikos, Do, Pc 2500 Nesconset Hwy Bldg 3c Stony Brook NY 11790-2551 Ph: (631) 751-2400 |
| NPI Number | 1861929861 |
|---|---|
| Provider Enumeration Date | 05/22/2017 |
| Last Update Date | 05/22/2017 |
| Medicare PECOS PAC ID | 0345510616 |
|---|---|
| Medicare Enrollment ID | O20170719000949 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861929861 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | 235458 (New York) | Primary |
| Provider Name | Theofanis Mitsinikos |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1467624064 PECOS PAC ID: 3971674953 Enrollment ID: I20080618000717 |
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