Provider Demographics
NPI:1568779700
Name:PASIAKOS, KOSTANTINA I
Entity Type:Individual
Prefix:DR
First Name:KOSTANTINA
Middle Name:I
Last Name:PASIAKOS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KOSTANTINA
Other - Middle Name:I
Other - Last Name:PASIAKOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1718 W 5TH ST
Mailing Address - Street 2:APT 2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1472
Mailing Address - Country:US
Mailing Address - Phone:718-627-8110
Mailing Address - Fax:
Practice Address - Street 1:240 ROUTE 22
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3506
Practice Address - Country:US
Practice Address - Phone:973-379-0766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28R103183200183500000X
NY20 054242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist