Provider Demographics
NPI:1205966124
Name:KINTIROGLOU, CONSTANTINOS (MD)
Entity type:Individual
Prefix:DR
First Name:CONSTANTINOS
Middle Name:
Last Name:KINTIROGLOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5011
Mailing Address - Country:US
Mailing Address - Phone:973-740-0548
Mailing Address - Fax:973-243-1227
Practice Address - Street 1:1500 PLEASANT VALLEY WAY
Practice Address - Street 2:STE 306
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2956
Practice Address - Country:US
Practice Address - Phone:973-243-0002
Practice Address - Fax:973-243-1227
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA031240002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine