Provider Demographics
NPI:1861611436
Name:ASPROGERAKAS, MARIA (OD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:ASPROGERAKAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1856
Mailing Address - Country:US
Mailing Address - Phone:718-274-5575
Mailing Address - Fax:718-274-9223
Practice Address - Street 1:3018 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1856
Practice Address - Country:US
Practice Address - Phone:718-274-5575
Practice Address - Fax:718-274-9223
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005640152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC0307Medicare ID - Type Unspecified
NYU57358Medicare UPIN