Provider Demographics
NPI:1215921861
Name:KYRIAKIDES, CHRISTOPHER (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:KYRIAKIDES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 ASTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3608
Mailing Address - Country:US
Mailing Address - Phone:718-274-7300
Mailing Address - Fax:718-274-3997
Practice Address - Street 1:3825 ASTORIA BLVD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3608
Practice Address - Country:US
Practice Address - Phone:718-274-7300
Practice Address - Fax:718-274-3997
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183380207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01600GOtherMEDICARE PTAN
NYF44456Medicare UPIN