Provider Demographics
NPI:1932131075
Name:PYRSOPOULOS, NIKOLAOS T (MD,PHD,MBA)
Entity type:Individual
Prefix:
First Name:NIKOLAOS
Middle Name:T
Last Name:PYRSOPOULOS
Suffix:
Gender:M
Credentials:MD,PHD,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HICKSVILLE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3472
Mailing Address - Country:US
Mailing Address - Phone:646-501-3229
Mailing Address - Fax:212-263-4539
Practice Address - Street 1:317 E 34TH ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4910
Practice Address - Country:US
Practice Address - Phone:212-263-8133
Practice Address - Fax:929-455-9840
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326644207RG0100X, 207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2730006-00Medicaid
16448Medicare ID - Type Unspecified
FL2730006-00Medicaid