Provider Demographics
NPI:1730747502
Name:GEORGIEV, KRISTIAN (MD)
Entity type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:
Last Name:GEORGIEV
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 1:151 SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1419
Mailing Address - Country:US
Mailing Address - Phone:845-242-9681
Mailing Address - Fax:240-335-7534
Practice Address - Street 1:16 E 79TH ST STE 14
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0150
Practice Address - Country:US
Practice Address - Phone:917-830-7287
Practice Address - Fax:240-335-7534
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY3226552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry