Healthcare Provider Details

I. General information

NPI: 1770558397
Provider Name (Legal Business Name): SRINIVAS KESANAKURTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
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 Number221556
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number221556
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number221556
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number221556
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: