Provider Demographics
NPI:1023315512
Name:SURGICAL SPECIALISTS OF GREATER NY LLP
Entity type:Organization
Organization Name:SURGICAL SPECIALISTS OF GREATER NY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PANAGIOTIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-626-0707
Mailing Address - Street 1:30-16 30TH DRIVE
Mailing Address - Street 2:SUITE 3-B
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1874
Mailing Address - Country:US
Mailing Address - Phone:718-626-0707
Mailing Address - Fax:718-545-0333
Practice Address - Street 1:3016 30TH DR
Practice Address - Street 2:SUITE 3-B
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1874
Practice Address - Country:US
Practice Address - Phone:718-626-0707
Practice Address - Fax:718-545-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100045709Medicare PIN