Individual
MR. COSTA FOTOPOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.D., M.S., C.N.S.
Contact information
Practice address
800 POLY PL, BROOKLYN, NY 11209-7104
(718) 836-6600
Mailing address
2726 FRANCIS LEWIS BLVD, FLUSHING, NY 11358-1147
(718) 358-5765
(718) 358-5765
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
000412-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000412-1
CERTIFIED NUTRITIONIST
NY
01
—
78P0031
NYPCHP
NY
01
—
P467422
OXFORD HEALTH PLANS
NY
Enumeration date
06/02/2006
Last updated
04/15/2008
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