Healthcare Provider Details

I. General information

NPI: 1750437695
Provider Name (Legal Business Name): CHRISTOPHER XIKIS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 S JERSEY AVE
SETAUKET NY
11733-2065
US

IV. Provider business mailing address

118 S BICYCLE PATH
SELDEN NY
11784-3827
US

V. Phone/Fax

Practice location:
  • Phone: 631-689-2700
  • Fax:
Mailing address:
  • Phone: 631-732-7976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009446
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: