Provider Demographics
NPI:1063588127
Name:YIACHOS, CONSTANTINE (MD)
Entity type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:
Last Name:YIACHOS
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 1:129 SLOSSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2522
Mailing Address - Country:US
Mailing Address - Phone:718-720-5928
Mailing Address - Fax:718-720-6706
Practice Address - Street 1:129 SLOSSON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2522
Practice Address - Country:US
Practice Address - Phone:718-720-5928
Practice Address - Fax:718-720-6706
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172409207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100013461OtherMEDICARE RAILROAD
CY2409OtherATLANTIS
7838085OtherAETNA
100109150502OtherAMERICHOICE
2C3244OtherHEALTHNET
172409OtherHIP
OS121OtherOXFORD
0076533OtherGHI
169907OtherELDERPLAN
78984OtherGHI HMO
CYO29F1510OtherEMPIRE BLUE CROSS BLUE SHIELD
169907OtherELDERPLAN
CYO29F1510OtherEMPIRE BLUE CROSS BLUE SHIELD