Provider Demographics
NPI:1487740981
Name:CHARLES TSAKRIOS JR. M.D PA
Entity type:Organization
Organization Name:CHARLES TSAKRIOS JR. M.D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:TSAKRIOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:201-445-1991
Mailing Address - Street 1:89 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3235
Mailing Address - Country:US
Mailing Address - Phone:201-445-1991
Mailing Address - Fax:201-445-4827
Practice Address - Street 1:89 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3235
Practice Address - Country:US
Practice Address - Phone:201-445-1991
Practice Address - Fax:201-445-4827
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES TSAKRIOS JR. M.D PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41737207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3295206Medicaid
NJ469537XQ8OtherMEDICARE RENDERING PIN
NJ120640Medicare PIN
NJDO6723Medicare UPIN
NJ0338130001Medicare NSC