Active NPI
Dimitrios John Fotiadis, MD PYSICIAN SURGEON
- Surgery Physician
- Clifton, NJ
National Provider Identifier
1336314889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 25MA01891100
- Practice address
- 337 Grove STR
Clifton, NJ 07013 - Phone
- (973) 779-3787
- Fax
- (973) 778-6433
- NPI assigned
- Apr 25, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 25MA01891100 | NJ | Primary |
| Vascular Surgery Physician | 2086S0129X | 25MA01891100 | NJ |
Addresses
Primary practice location
337 Grove STR
Clifton, NJ 07013
Mailing address
337 Grove STR
Clifton, NJ 07013
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA01891100 | NJ | MD | Vascular Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209081600000",
"number": "1336314889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "337 GROVE STR",
"city": "CLIFTON",
"state": "NJ",
"postal_code": "07013",
"fax_number": "973-778-6433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "337 GROVE STR",
"city": "CLIFTON",
"state": "NJ",
"postal_code": "07013",
"telephone_number": "973-779-3787",
"fax_number": "973-778-6433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOTIADIS",
"first_name": "DIMITRIOS",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "MD PYSICIAN SURGEON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-25",
"last_updated": "2008-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NJ",
"license": "25MA01891100",
"primary": true
},
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "NJ",
"license": "25MA01891100",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clifton, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.