Provider Demographics
NPI:1821324195
Name:ARK MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:ARK MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KADIANAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-271-9151
Mailing Address - Street 1:3810 WAVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2610
Mailing Address - Country:US
Mailing Address - Phone:631-271-9151
Mailing Address - Fax:631-271-9155
Practice Address - Street 1:3109 NEWTOWN AVE
Practice Address - Street 2:SUITE #211
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1373
Practice Address - Country:US
Practice Address - Phone:631-271-9151
Practice Address - Fax:631-271-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty