Provider Demographics
NPI:1093819203
Name:KINTZOGLOU, ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:KINTZOGLOU
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 1:10105 LEFFERTS BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2014
Mailing Address - Country:US
Mailing Address - Phone:718-441-8086
Mailing Address - Fax:718-441-8087
Practice Address - Street 1:10105 LEFFERTS BLVD STE 203
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2014
Practice Address - Country:US
Practice Address - Phone:718-441-8086
Practice Address - Fax:718-441-8087
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166870207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00964916Medicaid
NY1000015444OtherAFFINITY
NY750331OtherEMPIRE
E40729Medicare UPIN
59067Medicare ID - Type Unspecified