Provider Demographics
NPI:1497964951
Name:DEMETRIOS A KARIDES MD PC
Entity Type:Organization
Organization Name:DEMETRIOS A KARIDES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:KARIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-204-7821
Mailing Address - Street 1:PO BOX 5577
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-5577
Mailing Address - Country:US
Mailing Address - Phone:718-204-7821
Mailing Address - Fax:718-204-7826
Practice Address - Street 1:2309 31ST ST STE 5
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2452
Practice Address - Country:US
Practice Address - Phone:718-204-7821
Practice Address - Fax:718-204-7826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2106352084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00125338OtherMC RR
NY02258088Medicaid
NYP00125338OtherMC RR
NY02258088Medicaid