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Contact Information

NICOLAS MAVROMOUSTAKOS
14 BIRCH AVE
HUNTINGTON, NY11743-4655
 Phone: 631-662-5714
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for NICOLAS MAVROMOUSTAKOS · (Male)

NPI Number 1003440504
Status Active
Credentials
Entity Individual
Enumeration date 02/24/2020
Last updated 07/15/2021 - About 5 years ago
Sole proprietor 1 Yes
Identifiers
  • NY License # 026722
Hospital affiliation(s)
  • SOUTHSIDE HOSPITAL - (Acute Care)
    301 EAST MAIN STREET
    BAY SHORE, NY 11706
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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