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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578675971 | NPPES |
| New York | Other | 7V691EC831 | MEDICARE OTHER PIN |
| New York | MEDICAID | 02732167 | MEDICARE OTHER PIN |
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