Theodoris, Anthony C

Theodoris, Anthony C is an individual health care provider with primary practice located at 1500 Route 112 Ste B , Port Jefferson Station NY 11776-8054. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pulmonary Disease, which is considered as his primary health care specialty. Theodoris, Anthony C can be contacted via phone (631) 978-7633.

Contact Information

Primary practice address
1500 Route 112 Ste B Port Jefferson Station NY 11776-8054
Phone: (631) 978-7633
Fax: (631) 638-4884
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pulmonary Disease 207RP1001X 221756-1 New York

Profile Details

NPI number 1578675971
LBN Legal business name Theodoris, Anthony C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2006
Last updated Apr 29th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578675971 NPPES
New York Other 7V691EC831 MEDICARE OTHER PIN
New York MEDICAID 02732167 MEDICARE OTHER PIN

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