Provider Demographics
NPI:1720171119
Name:KYRIAKAKOS, ANASTASSIOS (MD)
Entity Type:Individual
Prefix:
First Name:ANASTASSIOS
Middle Name:
Last Name:KYRIAKAKOS
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:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-0518
Mailing Address - Country:US
Mailing Address - Phone:718-329-2275
Mailing Address - Fax:718-329-2276
Practice Address - Street 1:3050 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:718-329-2275
Practice Address - Fax:718-329-2276
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14120001208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00869847Medicaid
NY00869847Medicaid