Provider Demographics
NPI:1871565077
Name:CODOYANNIS, ARISTIDES BASIL (MD)
Entity type:Individual
Prefix:DR
First Name:ARISTIDES
Middle Name:BASIL
Last Name:CODOYANNIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13 GLENNON FARM LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-4504
Mailing Address - Country:US
Mailing Address - Phone:973-476-2039
Mailing Address - Fax:908-325-6343
Practice Address - Street 1:13 GLENNON FARM LN
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-4504
Practice Address - Country:US
Practice Address - Phone:973-476-2039
Practice Address - Fax:908-325-6343
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2014-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA33916208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ973009Medicaid
NJ198174Medicare PIN
D99028Medicare UPIN