Healthcare Provider Details

I. General information

NPI: 1881077055
Provider Name (Legal Business Name): SOTIRIOS T KEROS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E 63RD ST APT. E12F
NEW YORK NY
10065-7804
US

IV. Provider business mailing address

425 E 63RD ST APT. E12F
NEW YORK NY
10065-7804
US

V. Phone/Fax

Practice location:
  • Phone: 646-930-4738
  • Fax:
Mailing address:
  • Phone: 646-930-4738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number252777-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number252777-1
License Number StateNY

VIII. Authorized Official

Name: DR. SOTIRIOS TONY KEROS
Title or Position: OWNER
Credential: M.D.
Phone: 646-930-4738