Provider Demographics
NPI:1548686827
Name:KANTZILIERIS, PANAGIOTIS (DC)
Entity type:Individual
Prefix:DR
First Name:PANAGIOTIS
Middle Name:
Last Name:KANTZILIERIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 FURNACE AVE
Mailing Address - Street 2:
Mailing Address - City:WANAQUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07465-2006
Mailing Address - Country:US
Mailing Address - Phone:201-723-8385
Mailing Address - Fax:862-377-0490
Practice Address - Street 1:237 W MIDLAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1830
Practice Address - Country:US
Practice Address - Phone:201-857-5279
Practice Address - Fax:201-857-5281
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00714300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor