Provider Demographics
NPI:1750366449
Name:HADJIYANE, PERICLES S (MD)
Entity type:Individual
Prefix:DR
First Name:PERICLES
Middle Name:S
Last Name:HADJIYANE
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:PO BOX 7475
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-0475
Mailing Address - Country:US
Mailing Address - Phone:516-728-1771
Mailing Address - Fax:
Practice Address - Street 1:375 E BAY DR
Practice Address - Street 2:KOMANOFF CENTER FOR GERIATRIC REHAB
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2350
Practice Address - Country:US
Practice Address - Phone:516-728-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198348208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS0003581OtherSELECT PRO
NY198348OtherHIP
NY6358058002OtherCIGNA
NY67349OtherVYTRA
NY2C8868OtherHEALTHNET
NYP1537305OtherOXFORD
NYCPMR1298348-5OtherWC, NO FAULT
NY01755215Medicaid
NY11051997OtherMULTIPLAN
NY112573413OtherCNN,HUMN,GAL,HORZ,MAGN
NY2799832OtherGHI
NY130021357OtherRAILROAD MEDICARE
NY112573413OtherNGS,OHP,GRTWEST,PHCS,UHC,
NY83Y511OtherBC BS
NY970401OtherHEALTHCARE PARTNERS
NYP1537305OtherOXFORD
NY01755215Medicaid