Healthcare Provider Details

I. General information

NPI: 1861998940
Provider Name (Legal Business Name): BESTIN KURIAKOSE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E MAIN ST STE 102
SMITHTOWN NY
11787-2844
US

IV. Provider business mailing address

309 E MAIN ST STE 102
SMITHTOWN NY
11787-2844
US

V. Phone/Fax

Practice location:
  • Phone: 631-360-2200
  • Fax:
Mailing address:
  • Phone: 631-360-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number315827
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: