Healthcare Provider Details

I. General information

NPI: 1225665839
Provider Name (Legal Business Name): KONSTANTINOS CHRISTOS HANTZIDIAMANTIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 TOWNSHIP BLVD STE 20
CAMILLUS NY
13031-1678
US

IV. Provider business mailing address

260 TOWNSHIP BLVD STE 20
CAMILLUS NY
13031-1678
US

V. Phone/Fax

Practice location:
  • Phone: 315-708-0190
  • Fax: 315-488-3284
Mailing address:
  • Phone: 315-708-0091
  • Fax: 315-708-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number344133
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: