Healthcare Provider Details

I. General information

NPI: 1609381458
Provider Name (Legal Business Name): INTERBORO HEART & VASCULAR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 3RD AVE STE 201
BRONX NY
10455-4066
US

IV. Provider business mailing address

2825 3RD AVE STE 201
BRONX NY
10455-4066
US

V. Phone/Fax

Practice location:
  • Phone: 718-887-7171
  • Fax: 929-990-2928
Mailing address:
  • Phone: 718-887-7171
  • Fax: 929-990-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SRINIVAS KESANAKURTHY
Title or Position: PRESIDENT
Credential: MD
Phone: 718-887-7171