Provider Demographics
NPI:1275684391
Name:DELIGIANNIDIS, KRISTINA M (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:M
Last Name:DELIGIANNIDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7559 263RD ST
Mailing Address - Street 2:ZUCKER HILLSIDE HOSP. AMBULATORY CARE PAVILION, PRA-12
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1150
Mailing Address - Country:US
Mailing Address - Phone:718-470-8184
Mailing Address - Fax:
Practice Address - Street 1:7559 263RD ST
Practice Address - Street 2:ZUCKER HILLSIDE HOSP. AMBULATORY CARE PAVILION, PRA-12
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1150
Practice Address - Country:US
Practice Address - Phone:718-470-8184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2318282084P0800X
NY285159-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083663AMedicaid
MA110083663AMedicaid