Provider Demographics
NPI:1902948375
Name:KALLOPOULOS, PARTHENA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:PARTHENA
Middle Name:
Last Name:KALLOPOULOS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S DEAN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3750
Mailing Address - Country:US
Mailing Address - Phone:551-289-9499
Mailing Address - Fax:
Practice Address - Street 1:15 S DEAN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3750
Practice Address - Country:US
Practice Address - Phone:201-944-1343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00190300363A00000X
NY23 012151363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2695521801Medicare PIN