Healthcare Provider Details

I. General information

NPI: 1225314495
Provider Name (Legal Business Name): SOULTANA KOURTIDOU MD, MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 7TH AVE
BROOKLYN NY
11215-7247
US

IV. Provider business mailing address

237 11TH ST APT 10B
BROOKLYN NY
11215-4537
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-5260
  • Fax:
Mailing address:
  • Phone: 516-503-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number296478
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: