George Stamboulis, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

2408 32ND St Ste 1002D
Astoria, NY 11102-1139

Phone

(718) 734-2373

Fax

(718) 734-2372

NPI assigned

Aug 25, 2017

Reactivated

Jan 23, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Soma Physical and Occupational Therapy PLLCGroup PAC ID 9234538927, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Soma Physical and Occupational Therapy PLLC

  • Physical Therapist
  • Astoria, NY
  • NPI 1144804261
  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1609393131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2408 32ND ST STE 1002D",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111021139",
            "telephone_number": "718-734-2373",
            "fax_number": "212-379-2123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2408 32ND ST STE 1002D",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111021139",
            "telephone_number": "718-734-2373",
            "fax_number": "718-734-2372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAMBOULIS",
        "first_name": "GEORGE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-25",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "deactivation_date": "2018-12-26",
        "reactivation_date": "2019-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anita Srdanovic Parris
• Ssy Acupuncture PLLC
• Mark Stadlen
• Joanne Stalzer, RN
• Costantinos Stamboulis, OTR/L
• Starshine LLC
• Statewide Interventional Pain Medicine, P.C.
• Ioannis Stathopoulos, MD
• Stuart Lance Stauber, MD
• Marzena Stec, PT

• Physical Therapist in Astoria, NY
• Providers in Astoria, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.