Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 166870 | NY |
NPI | 1093819203 |
---|---|
Provider Name | Dr. Alexander Kintzoglou |
First Address | South Richmond Hill, NY 11419-2014 |
Second Address | South Richmond Hill, NY 11419-2014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2006 |
Last Update Date | 07/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00964916 | (05) | NY |
1000015444 | AFFINITY (01) | NY |
750331 | EMPIRE (01) | NY |
E40729 | (02) |