Healthcare Provider Details

I. General information

NPI: 1699881383
Provider Name (Legal Business Name): PETER ROUVELAS, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 7TH AVE
BROOKLYN NY
11228-2804
US

IV. Provider business mailing address

8115 7TH AVE
BROOKLYN NY
11228-2804
US

V. Phone/Fax

Practice location:
  • Phone: 718-833-5303
  • Fax: 718-833-5304
Mailing address:
  • Phone: 718-833-5303
  • Fax: 718-833-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number193878-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number193878-1
License Number StateNY

VIII. Authorized Official

Name: DR. PETER ROUVELAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 646-897-6694