Provider Demographics
NPI:1225247562
Name:CHRYSSOS, EMANUEL DEMETRIOS (MD)
Entity Type:Individual
Prefix:DR
First Name:EMANUEL
Middle Name:DEMETRIOS
Last Name:CHRYSSOS
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 1:45 RESEARCH WAY STE 108
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6401
Mailing Address - Country:US
Mailing Address - Phone:631-941-2000
Mailing Address - Fax:631-941-2010
Practice Address - Street 1:45 RESEARCH WAY
Practice Address - Street 2:SUITE 208
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-6401
Practice Address - Country:US
Practice Address - Phone:631-941-2000
Practice Address - Fax:631-941-2010
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT185110207R00000X
LAMD201464207RC0000X
NY255976207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine