Provider Demographics
NPI:1316081763
Name:SARRIS, ATHANASIOS K (DC)
Entity type:Individual
Prefix:MR
First Name:ATHANASIOS
Middle Name:K
Last Name:SARRIS
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 1:16 NEW KARNER RD
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-9514
Mailing Address - Country:US
Mailing Address - Phone:518-456-3725
Mailing Address - Fax:518-452-4941
Practice Address - Street 1:16 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084-9514
Practice Address - Country:US
Practice Address - Phone:518-456-3725
Practice Address - Fax:518-452-4941
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0878Medicare ID - Type Unspecified