Basic Information
| Provider Information | |||||||||
| NPI: | 1922380203 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKOULIS | ||||||||
| FirstName: | ANASTASIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | STONY BROOK SURGICAL ASSOCIATES HSC T19, ROOM 20 | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117948191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314445976 | ||||||||
| FaxNumber: | 6314446348 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 EDMUND D PELLEGRINO RD | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117942594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316381000 | ||||||||
| FaxNumber: | 6316380720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 284277 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.