Provider Demographics
NPI:1588998850
Name:AFTHINOS, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:AFTHINOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20817 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1115
Mailing Address - Country:US
Mailing Address - Phone:646-522-1309
Mailing Address - Fax:
Practice Address - Street 1:131 E MARKET ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3915
Practice Address - Country:US
Practice Address - Phone:919-934-5441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-19
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238008-1208600000X
NC2021-01685208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03361039Medicaid
NYA400053162Medicare PIN