Provider Demographics
NPI:1578709556
Name:CONSTANTIN C ANAGNOSTOPOULOS MD PC
Entity Type:Organization
Organization Name:CONSTANTIN C ANAGNOSTOPOULOS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANAGNOSTOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-545-4080
Mailing Address - Street 1:33 PEPPERMILL ROAD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3105
Mailing Address - Country:US
Mailing Address - Phone:718-545-4080
Mailing Address - Fax:
Practice Address - Street 1:30-14 31ST AVENUE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-2405
Practice Address - Country:US
Practice Address - Phone:718-545-4080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty