Healthcare Provider Details

I. General information

NPI: 1962720722
Provider Name (Legal Business Name): STEINWAY ADVANCED MEDICAL P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 38TH ST FL 2
ASTORIA NY
11103-3804
US

IV. Provider business mailing address

3010 38TH ST FL 2
ASTORIA NY
11103-3804
US

V. Phone/Fax

Practice location:
  • Phone: 718-545-2020
  • Fax: 718-932-9131
Mailing address:
  • Phone: 718-545-2020
  • Fax: 718-932-9131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number246636
License Number StateNY

VIII. Authorized Official

Name: DR. THOMAS MASTAKOURIS
Title or Position: PRESITENT
Credential: M.D
Phone: 718-545-2020