Provider Demographics
NPI:1427022649
Name:KESSARIS, DIMITRI NIKITAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMITRI
Middle Name:NIKITAS
Last Name:KESSARIS
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 1:315 EAST SHORE RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-487-5577
Mailing Address - Fax:516-487-2947
Practice Address - Street 1:315 EAST SHORE RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-487-5577
Practice Address - Fax:516-487-2947
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1944221208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04172GOtherGHI MEDICARE
NY01639683Medicaid
NY01639683Medicaid
NY04172GOtherGHI MEDICARE