Healthcare Provider Details

I. General information

NPI: 1528320611
Provider Name (Legal Business Name): CHRYSSANTHI KARACHALIOS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 31ST ST
ASTORIA NY
11105-2298
US

IV. Provider business mailing address

42 OAK ST
HICKSVILLE NY
11801-3238
US

V. Phone/Fax

Practice location:
  • Phone: 718-932-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number283570
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number283570-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: