Basic Information
| Provider Information | |||||||||
| NPI: | 1780880435 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TZIMAS | ||||||||
| FirstName: | KONSTANTINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29 VALLEY CRES | ||||||||
| Address2: | |||||||||
| City: | PENFIELD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145262509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854157280 | ||||||||
| FaxNumber: | 5852760122 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 604 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852751385 | ||||||||
| FaxNumber: | 5852447271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2007 | ||||||||
| LastUpdateDate: | 08/15/2012 | ||||||||
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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 | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 255305 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.