Provider Demographics
NPI:1558495887
Name:FOTIOU, KONSTANTINE A (DC)
Entity Type:Individual
Prefix:DR
First Name:KONSTANTINE
Middle Name:A
Last Name:FOTIOU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4406
Mailing Address - Country:US
Mailing Address - Phone:848-203-3280
Mailing Address - Fax:
Practice Address - Street 1:274 HIGH ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4406
Practice Address - Country:US
Practice Address - Phone:848-203-3280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor