Provider Demographics
NPI:1679710115
Name:ARIKOSTADARAS,M.D.,P.C.
Entity type:Organization
Organization Name:ARIKOSTADARAS,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTADARAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-721-4440
Mailing Address - Street 1:2510 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4224
Mailing Address - Country:US
Mailing Address - Phone:718-721-4440
Mailing Address - Fax:718-907-7932
Practice Address - Street 1:2318 31ST ST
Practice Address - Street 2:SUITE 220
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2892
Practice Address - Country:US
Practice Address - Phone:718-721-4440
Practice Address - Fax:718-907-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189511174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY189511OtherLICENSE
NY01546501Medicaid
NY00612Medicare PIN