Basic Information
| Provider Information | |||||||||
| NPI: | 1003366576 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAMBOULIS | ||||||||
| FirstName: | COSTANTINOS | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14916 17TH RD | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113572542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176623041 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2408 32ND ST STE 1002D | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111021139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187342373 | ||||||||
| FaxNumber: | 7187342372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2016 | ||||||||
| LastUpdateDate: | 05/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 020698 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.