Provider Demographics
NPI:1871597641
Name:STROUMBAKIS, NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:STROUMBAKIS
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 1:49 LAKE AVE
Mailing Address - Street 2:# 21
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4501
Mailing Address - Country:US
Mailing Address - Phone:203-869-1285
Mailing Address - Fax:203-869-1959
Practice Address - Street 1:49 LAKE AVE
Practice Address - Street 2:# 21
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4501
Practice Address - Country:US
Practice Address - Phone:203-869-1285
Practice Address - Fax:203-869-1959
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035077208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1350777Medicaid
2036918OtherAETNA
P437136OtherOXFORD
010035077CT01OtherBC/BS
020231OtherHEALTHNET
340011882OtherRAILROAD MEDICARE
035077OtherCONNETICARE
P437136OtherOXFORD
CTG26434Medicare UPIN
CT340000263Medicare ID - Type Unspecified