Provider Demographics
NPI:1073505343
Name:KALLINIKOS, KONSTANTINOS GUS (DPM)
Entity type:Individual
Prefix:DR
First Name:KONSTANTINOS
Middle Name:GUS
Last Name:KALLINIKOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 NEPTUNE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4010
Mailing Address - Country:US
Mailing Address - Phone:718-996-6000
Mailing Address - Fax:718-996-6019
Practice Address - Street 1:525 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4063
Practice Address - Country:US
Practice Address - Phone:718-996-6000
Practice Address - Fax:718-996-6019
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005435213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY480034729OtherMEDICARE RAILROAD
NY4C0018OtherPHS
NYP1946748OtherOXFORD
NY03655OtherGHI MEDICARE
NYN005435OtherHIP
NC161148OtherELDERPLAN
NY2700985OtherEVERCARE
NY6201697OtherGHI
NY01977971Medicaid
NY1902861OtherUNITED HEALTH CARE
NC161148OtherELDERPLAN
NY4C0018OtherPHS