| George John Koullias, MD | |
|
100 Hospital Rd, Suite 203, East Patchogue, NY 11772-8809 | |
| (631) 438-5030 | |
| (631) 447-5954 |
| Full Name | George John Koullias |
|---|---|
| Gender | Male |
| Speciality | Vascular Surgery |
| Experience | 34 Years |
| Location | 100 Hospital Rd, East Patchogue, New York |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992986509 | NPI | - | NPPES |
| 03619605 | Other | IL | IL LICENSE |
| 039729 | Other | CT | CT LICENSE |
| 262079 | Other | NY | MEDICAL BOARD-NY STATE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208G00000X | Thoracic Surgery (cardiothoracic Vascular Surgery) | 036119605 (Illinois) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Catholic Home Care | Farmingdale, NY | Home health agency |
| Chsli St Joseph Hospital | Bethpage, NY | Hospital |
| St Catherine Of Siena Hospital | Smithtown, NY | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Chs Physician Partners Pc | 7618955667 | 618 |
| Entity Name | Chs Physician Partners Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1124497771 PECOS PAC ID: 7618955667 Enrollment ID: O20040708000027 |
| Mailing Address | Practice Location Address |
|---|---|
| George John Koullias, MD 100 Hospital Rd, Suite 203, East Patchogue, NY 11772-8809 Ph: (631) 438-5030 | George John Koullias, MD 100 Hospital Rd, Suite 203, East Patchogue, NY 11772-8809 Ph: (631) 438-5030 |
Richard B Rubenstein, MD Thoracic Surgery (Cardiothoracic Vascular Surgery) Medicare: Not Enrolled in Medicare Practice Location: 250 Patchogue Yaphank Rd, Suite 5a, East Patchogue, NY 11772 Phone: 631-475-1013 Fax: 631-475-1092 |