Healthcare Provider Details

I. General information

NPI: 1922197409
Provider Name (Legal Business Name): CONSTANTINE ANTONY PANDAZIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 STEWART AVE SUITE 285
GARDEN CITY NY
11530-4893
US

IV. Provider business mailing address

901 STEWART AVE SUITE 285
GARDEN CITY NY
11530-4893
US

V. Phone/Fax

Practice location:
  • Phone: 516-742-5715
  • Fax: 516-742-1740
Mailing address:
  • Phone: 516-742-5715
  • Fax: 516-742-1740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberX005093-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: