Provider Demographics
NPI:1396708368
Name:GEORGIOU, ANASTASIOS K
Entity type:Individual
Prefix:DR
First Name:ANASTASIOS
Middle Name:K
Last Name:GEORGIOU
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 1:80 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4104
Mailing Address - Country:US
Mailing Address - Phone:203-431-4343
Mailing Address - Fax:203-431-3423
Practice Address - Street 1:80 GROVE ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4104
Practice Address - Country:US
Practice Address - Phone:203-431-4343
Practice Address - Fax:203-431-3423
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001517171100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1396708368OtherOXFORD