Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 183380 | NY |
NPI | 1215921861 |
---|---|
Provider Name | Dr. Christopher Kyriakides |
First Address | Astoria, NY 11103-3608 |
Second Address | Astoria, NY 11103-3608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 29/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01600G | MEDICARE PTAN (01) | NY |
F44456 | (02) | NY |