Individual
DEMETRIOS GORGIOS FUIAXIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
770 GRAND BLVD, DEER PARK, NY 11729-5750
(631) 392-4357
(631) 392-4358
Mailing address
770 GRAND BLVD, DEER PARK, NY 11729-5750
(631) 392-4357
(631) 392-4358
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NY
Other
Enumeration date
10/15/2019
Last updated
10/15/2019
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