Provider Demographics
NPI:1922197409
Name:PANDAZIS, CONSTANTINE ANTONY (DC)
Entity Type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:ANTONY
Last Name:PANDAZIS
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 1:901 STEWART AVE
Mailing Address - Street 2:SUITE 285
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4893
Mailing Address - Country:US
Mailing Address - Phone:516-742-5715
Mailing Address - Fax:516-742-1740
Practice Address - Street 1:901 STEWART AVE
Practice Address - Street 2:SUITE 285
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4893
Practice Address - Country:US
Practice Address - Phone:516-742-5715
Practice Address - Fax:516-742-1740
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005093-1111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX18B9XM401Medicare PIN