Healthcare Provider Details

I. General information

NPI: 1043281280
Provider Name (Legal Business Name): EMANUEL L KOUROUPOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2747 CRESCENT ST SUITE 206
ASTORIA NY
11102
US

IV. Provider business mailing address

27-47 CRESCENT STREET SUITE 206
ASTORIA NY
11102
US

V. Phone/Fax

Practice location:
  • Phone: 718-204-1100
  • Fax: 718-204-2049
Mailing address:
  • Phone: 718-204-1100
  • Fax: 718-204-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number155527-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number155527-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number155527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: