Provider Demographics
NPI:1962766709
Name:ARISTOTELIS SAKELLARIDIS, MD, PC
Entity type:Organization
Organization Name:ARISTOTELIS SAKELLARIDIS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARISTOTELIS
Authorized Official - Middle Name:V
Authorized Official - Last Name:SAKELLARIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-935-1312
Mailing Address - Street 1:400 S OYSTER BAY RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3500
Mailing Address - Country:US
Mailing Address - Phone:516-935-1312
Mailing Address - Fax:516-935-9405
Practice Address - Street 1:400 S OYSTER BAY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3500
Practice Address - Country:US
Practice Address - Phone:516-935-1312
Practice Address - Fax:516-935-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183829-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03551493Medicaid
NY03551493Medicaid