Provider Demographics
NPI:1659382349
Name:KYREAKAKIS, ANTHONY J (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:KYREAKAKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:KYREAKAKIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:604 WILLOW AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030
Mailing Address - Country:US
Mailing Address - Phone:201-659-3311
Mailing Address - Fax:201-795-0924
Practice Address - Street 1:604 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4175
Practice Address - Country:US
Practice Address - Phone:201-659-3311
Practice Address - Fax:201-795-0924
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39279207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1387405Medicaid
C55218Medicare UPIN
KY451557Medicare ID - Type Unspecified