Healthcare Provider Details

I. General information

NPI: 1215921861
Provider Name (Legal Business Name): CHRISTOPHER KYRIAKIDES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 ASTORIA BLVD
ASTORIA NY
11103-3608
US

IV. Provider business mailing address

3825 ASTORIA BLVD
ASTORIA NY
11103-3608
US

V. Phone/Fax

Practice location:
  • Phone: 718-274-7300
  • Fax: 718-274-3997
Mailing address:
  • Phone: 718-274-7300
  • Fax: 718-274-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number183380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: