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NPI Code Detail

MEDICARE: DR. CHRISTOPHER KYRIAKIDES D.O.

MEDICARE: DR. CHRISTOPHER KYRIAKIDES D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QS0010XSports Medicine (Family Medicine) Physician183380NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101600GOTHERNYMEDICARE PTAN

General Provider Information

NPI Number : 1215921861
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTOPHER KYRIAKIDES D.O.
Provider Business Mailing Address
First Line : 3825 ASTORIA BLVD
Second Line :
City : ASTORIA
State : NY
Zip : 11103-3608
Country : US
Telephone Number : 718-274-7300
Fax Number : 718-274-3997
Provider Business Practice Location Address
First Line : 3825 ASTORIA BLVD
Second Line :
City : ASTORIA
State : NY
Zip : 11103-3608
Country : US
Telephone Number : 718-274-7300
Fax Number : 718-274-3997
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2005
Last Update Date : 12/29/2011

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