Provider Demographics
NPI:1255393740
Name:CHRISTAKOS, MANNY E (MD)
Entity type:Individual
Prefix:
First Name:MANNY
Middle Name:E
Last Name:CHRISTAKOS
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 1:871 ALLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012
Mailing Address - Country:US
Mailing Address - Phone:973-779-2270
Mailing Address - Fax:973-779-5250
Practice Address - Street 1:871 ALLWOOD RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012
Practice Address - Country:US
Practice Address - Phone:973-779-2270
Practice Address - Fax:973-779-5250
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03765700208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0764205Medicaid
C58331Medicare UPIN
029003AWTMedicare ID - Type Unspecified