Provider Demographics
NPI:1043371487
Name:GEORGOPOULOS, STEVE KIRIAKO (MD)
Entity type:Individual
Prefix:MR
First Name:STEVE
Middle Name:KIRIAKO
Last Name:GEORGOPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 MEETING HOUSE LN
Mailing Address - Street 2:405
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5087
Mailing Address - Country:US
Mailing Address - Phone:631-283-5555
Mailing Address - Fax:631-283-0345
Practice Address - Street 1:889 E MAIN ST STE 308
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2681
Practice Address - Country:US
Practice Address - Phone:631-386-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194726174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY194726OtherNY STATE M.D. LICENSE
NYBG5269495OtherDEA
NY3V2811Medicare PIN
NY194726OtherNY STATE M.D. LICENSE