Healthcare Provider Details

I. General information

NPI: 1043405541
Provider Name (Legal Business Name): NARAYANAN DEEPAK KARAYIL THEKKOOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2007
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 10TH AVE
BROOKLYN NY
11219-2916
US

IV. Provider business mailing address

4802 10TH AVE
BROOKLYN NY
11219-2916
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-8958
  • Fax: 718-635-7105
Mailing address:
  • Phone: 718-283-8958
  • Fax: 718-635-7105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD201962
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number247024
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number201962
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: