Provider Demographics
NPI:1992790695
Name:TSOPELAS, JOANNA (MD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:TSOPELAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 48TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2919
Mailing Address - Country:US
Mailing Address - Phone:718-283-8015
Mailing Address - Fax:718-635-7235
Practice Address - Street 1:1301 57TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4636
Practice Address - Country:US
Practice Address - Phone:718-283-3640
Practice Address - Fax:718-635-7235
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY341500701OtherHEALTH PLUS
NY2604498OtherGHI
NY4C5698OtherHEALTH NET
NY7199138OtherAETNA PPO
NYBK00758-03OtherAMERICHOICE
NYTJ1278OtherATLANTIS HEALTH
NY01919126Medicaid
NY567Z31OtherEMPIRE BCBS
NYP2049946OtherOXFORD HEALTH
NY211278OtherHIP
NY1929374 10OtherUNITED HEALTHCARE
NY211278-A15OtherHEALTH FIRST
NY3261993OtherAETNA USHC HMO
NY7199138OtherAETNA PPO
NY551682Medicare ID - Type Unspecified