Provider Demographics
NPI:1508874785
Name:CHRISTODOULIDOU, FLORENTIA (MD)
Entity Type:Individual
Prefix:DR
First Name:FLORENTIA
Middle Name:
Last Name:CHRISTODOULIDOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2747 CRESCENT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3142
Mailing Address - Country:US
Mailing Address - Phone:718-932-3100
Mailing Address - Fax:718-726-7385
Practice Address - Street 1:2747 CRESCENT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3142
Practice Address - Country:US
Practice Address - Phone:718-932-3100
Practice Address - Fax:718-726-7385
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01182609Medicaid
NY01182609Medicaid
75370BMedicare ID - Type Unspecified