Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MA03124000 | NJ |
NPI | 1205966124 |
---|---|
Provider Name | Dr. Constantinos Kintiroglou |
First Address | Livingston, NJ 07039-5011 |
Second Address | West Orange, NJ 07052-2956 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |