Provider Demographics
NPI:1972897304
Name:MOUSTAKAS, GEORGE (MED)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:MOUSTAKAS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 N HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-3702
Mailing Address - Country:US
Mailing Address - Phone:267-784-1096
Mailing Address - Fax:
Practice Address - Street 1:2288 SECOND STREET PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-4108
Practice Address - Country:US
Practice Address - Phone:215-598-0223
Practice Address - Fax:215-598-9020
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health