Provider Demographics
NPI:1265519532
Name:GEORGIOU, CONSTANTINE JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:CONSTANTINE
Middle Name:JOHN
Last Name:GEORGIOU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1820
Mailing Address - Country:US
Mailing Address - Phone:914-963-0679
Mailing Address - Fax:914-476-3100
Practice Address - Street 1:770 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1820
Practice Address - Country:US
Practice Address - Phone:914-963-0679
Practice Address - Fax:914-476-3100
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00550610Medicaid