Provider Demographics
NPI:1780098137
Name:PERICLES HADJIYANE
Entity type:Organization
Organization Name:PERICLES HADJIYANE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERICLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HADJIYANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-596-0500
Mailing Address - Street 1:263 RINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1902
Mailing Address - Country:US
Mailing Address - Phone:516-596-0500
Mailing Address - Fax:
Practice Address - Street 1:815 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2922
Practice Address - Country:US
Practice Address - Phone:516-596-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA198348208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY83Y511OtherBCBS