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1003440504
NICOLAS MAVROMOUSTAKOS
HUNTINGTON, NY
NPI
1003440504
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363A00000X Physician Assistant
(Licence: NY 026722)
Enumeration Date
2020-02-24
Last Update Date
2021-07-15
Business Address
NICOLAS MAVROMOUSTAKOS
14 BIRCH AVE
HUNTINGTON, NY 11743-4655
Phone number: 631-662-5714
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Mailing Address
NICOLAS MAVROMOUSTAKOS
14 BIRCH AVE
HUNTINGTON, NY 11743-4655
Phone number:
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