Healthcare Provider Details

I. General information

NPI: 1316381197
Provider Name (Legal Business Name): ANTONIOS KOTSAFTIS PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 24TH ST
ASTORIA NY
11105-3452
US

IV. Provider business mailing address

2232 24TH ST
ASTORIA NY
11105-3452
US

V. Phone/Fax

Practice location:
  • Phone: 347-885-5997
  • Fax:
Mailing address:
  • Phone: 347-885-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number013764
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: