MEDICARE: DR. KOSTANTINOS PANTELIS POULIKIDIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	25MA11659600	NJ

General Provider Information

NPI Number	:	1689018830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KOSTANTINOS PANTELIS POULIKIDIS M.D.

Provider Business Mailing Address
First Line	:	80 JAMES ST
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-3938
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 JAMES ST
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-3938
Country	:	US
Telephone Number	:	732-635-9300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2013
Last Update Date	:	01/22/2026

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Directions to “ DR. KOSTANTINOS PANTELIS POULIKIDIS M.D.” Practice Location

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