Healthcare Provider Details

I. General information

NPI: 1417999806
Provider Name (Legal Business Name): PEDRO KOURTESIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 30TH AVE
ASTORIA NY
11102
US

IV. Provider business mailing address

2510 30TH AVE
ASTORIA NY
11102-2448
US

V. Phone/Fax

Practice location:
  • Phone: 718-606-9965
  • Fax:
Mailing address:
  • Phone: 718-606-9965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number127000
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number127000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: