Healthcare Provider Details

I. General information

NPI: 1073505343
Provider Name (Legal Business Name): KONSTANTINOS GUS KALLINIKOS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 NEPTUNE AVE
BROOKLYN NY
11224-4063
US

IV. Provider business mailing address

532 NEPTUNE AVE SUITE 203
BROOKLYN NY
11224-4010
US

V. Phone/Fax

Practice location:
  • Phone: 718-996-6000
  • Fax: 718-996-6019
Mailing address:
  • Phone: 718-996-6000
  • Fax: 718-996-6019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005435
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: