=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184654022
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C. BAKAS DO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 S BEDFORD RD STE. 413
-----------------------------------------------------
City | MOUNT KISCO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10549-3439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-666-5780
-----------------------------------------------------
Fax | 914-666-7980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 S BEDFORD RD STE. 413
-----------------------------------------------------
City | MOUNT KISCO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10549-3439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-666-5780
-----------------------------------------------------
Fax | 914-666-7980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CONSTANTINE BAKAS
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 914-666-5780
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 184658
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------