Provider Demographics
NPI:1356506562
Name:CHRISTOPHER KYRIAKIDES,D.O.SPORTSMEDICINE&ORTHOPEDICREHABILITATION,PC
Entity Type:Organization
Organization Name:CHRISTOPHER KYRIAKIDES,D.O.SPORTSMEDICINE&ORTHOPEDICREHABILITATION,PC
Other - Org Name:NEW YORK ORTHOPAEDIC SURGERY AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KYRIAKIDES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-274-5300
Mailing Address - Street 1:3825 ASTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3608
Mailing Address - Country:US
Mailing Address - Phone:718-274-7300
Mailing Address - Fax:
Practice Address - Street 1:3825 ASTORIA BLVD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3608
Practice Address - Country:US
Practice Address - Phone:718-274-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183380208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01600OtherMEDICARE PTAN
NY01600OtherMEDICARE PTAN