Provider Demographics
NPI:1043216559
Name:HALIASOS, CONSTANTINE A (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANTINE
Middle Name:A
Last Name:HALIASOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 TRINITY PL
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1626
Mailing Address - Country:US
Mailing Address - Phone:516-483-9688
Mailing Address - Fax:
Practice Address - Street 1:146 TRINITY PL
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1626
Practice Address - Country:US
Practice Address - Phone:516-483-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08558Medicare UPIN