Individual
GEORGE JOHN KOULLIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 HOSPITAL RD, SUITE 203, EAST PATCHOGUE, NY 11772-8809
(631) 438-5030
(631) 447-5954
Mailing address
100 HOSPITAL RD, SUITE 203, EAST PATCHOGUE, NY 11772-8809
(631) 438-5030
(631) 447-5954
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
036119605
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03619605
IL LICENSE
IL
01
—
039729
CT LICENSE
CT
01
—
262079
MEDICAL BOARD-NY STATE
NY
Enumeration date
11/26/2007
Last updated
11/14/2013
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