Provider Demographics
NPI:1265592653
Name:CHRISTODOULOU, JAMES P (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:CHRISTODOULOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7326
Mailing Address - Country:US
Mailing Address - Phone:212-744-1118
Mailing Address - Fax:212-744-1119
Practice Address - Street 1:625 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7326
Practice Address - Country:US
Practice Address - Phone:212-744-1118
Practice Address - Fax:212-744-1119
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099508207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY653801Medicare ID - Type Unspecified
B17566Medicare UPIN