Healthcare Provider Details

I. General information

NPI: 1952372963
Provider Name (Legal Business Name): PETER PATETSIOS M.D., F.A.C.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20606 HILLSIDE AVE
QUEENS VILLAGE NY
11427-1710
US

IV. Provider business mailing address

PO BOX 416173
BOSTON MA
02241-6173
US

V. Phone/Fax

Practice location:
  • Phone: 718-820-9729
  • Fax: 718-820-9730
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number201537
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: