Basic Information
| Provider Information | |||||||||
| NPI: | 1720070600 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AGORITSAS | ||||||||
| FirstName: | KONSTANTINOS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 LENOX RD | ||||||||
| Address2: | BOX 1262 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182454790 | ||||||||
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| Practice Location | |||||||||
| Address1: | 445 LENOX RD | ||||||||
| Address2: | BOX 1262 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182454790 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 236594-1 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02702207 | 05 | NY | MEDICAID |