Basic Information
Provider Information
NPI: 1003142324
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MICHAILDIIS
FirstName: ELENI
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 124 W 72ND ST
Address2: #6B
City: NEW YORK
State: NY
PostalCode: 100233356
CountryCode: US
TelephoneNumber: 2127694228
FaxNumber:  
Practice Location
Address1: 124 W 72ND ST
Address2: #6B
City: NEW YORK
State: NY
PostalCode: 100233356
CountryCode: US
TelephoneNumber: 2127694228
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/21/2009
LastUpdateDate: 10/21/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223X0400X054583NYY Dental ProvidersDentistOrthodontics and Dentofacial Orthopedics

No ID Information.


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