Provider Demographics
NPI:1285792499
Name:SOFOS, KONSTANTINOS GEORGE (DC)
Entity type:Individual
Prefix:
First Name:KONSTANTINOS
Middle Name:GEORGE
Last Name:SOFOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MAMARONECK AVE
Mailing Address - Street 2:105
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1315
Mailing Address - Country:US
Mailing Address - Phone:914-686-8844
Mailing Address - Fax:914-686-8842
Practice Address - Street 1:235 MAMARONECK AVE
Practice Address - Street 2:105
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1315
Practice Address - Country:US
Practice Address - Phone:914-686-8844
Practice Address - Fax:914-686-8842
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor