# THEOFANIS MITSINIKOS, DO, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861929861
- **Authorized official:** DR. THEOFANIS MITSINIKOS DO (OWNER)
- **Authorized official phone:** (631) 751-2400

## Contact information

- **Practice address:** 2500 NESCONSET HWY BLDG 3C, STONY BROOK, NY 11790-2551
- **Practice address phone:** (631) 751-2400
- **Practice address fax:** (631) 751-8323
- **Mailing address:** 2500 NESCONSET HWY BLDG 3C, STONY BROOK, NY 11790-2551

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | 235458 | NY | Yes |

## Other

- **Enumeration date:** 05/22/2017
- **Last updated:** 05/22/2017