Provider Demographics
NPI:1366593485
Name:DELIGIANNIDIS, KONSTANTINOS (MD)
Entity type:Individual
Prefix:DR
First Name:KONSTANTINOS
Middle Name:
Last Name:DELIGIANNIDIS
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 1:1983 MARCUS AVE
Mailing Address - Street 2:SUITE C102
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2000
Mailing Address - Country:US
Mailing Address - Phone:516-876-4100
Mailing Address - Fax:516-876-4101
Practice Address - Street 1:1983 MARCUS AVE
Practice Address - Street 2:SUITE C102
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2000
Practice Address - Country:US
Practice Address - Phone:516-876-4100
Practice Address - Fax:516-876-4101
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2140292Medicaid
NY2140292Medicaid