MEDICARE: MR. CHRISTIAN TSAKANIKAS ATC

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
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1386379261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTIAN TSAKANIKAS ATC

Provider Business Mailing Address
First Line	:	PO BOX 475
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-0475
Country	:	US
Telephone Number	:	914-483-7642
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 N SALEM RD
Second Line	:
City	:	CROSS RIVER
State	:	NY
Zip	:	10518-1104
Country	:	US
Telephone Number	:	914-763-7485
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2022
Last Update Date	:	07/23/2022

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