Provider Demographics
NPI:1417049727
Name:LIAKEAS, GEORGE P (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:P
Last Name:LIAKEAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 E 79TH ST # 1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0437
Mailing Address - Country:US
Mailing Address - Phone:646-564-2900
Mailing Address - Fax:646-328-0804
Practice Address - Street 1:180 E 79TH ST # 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0437
Practice Address - Country:US
Practice Address - Phone:646-564-2900
Practice Address - Fax:646-328-0804
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY217334OtherNYS MEDICAL LICENSE
BL6825092OtherDEA #
BL6825092OtherDEA #