Healthcare Provider Details

I. General information

NPI: 1740568286
Provider Name (Legal Business Name): PETER VRATIMOS MA, MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 B FORT TOTTEN
BAYSIDE NY
11364
US

IV. Provider business mailing address

413 B FORT TOTTEN
BAYSIDE NY
11364
US

V. Phone/Fax

Practice location:
  • Phone: 718-352-2140
  • Fax:
Mailing address:
  • Phone: 718-352-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: