Healthcare Provider Details

I. General information

NPI: 1417082785
Provider Name (Legal Business Name): SOTIRIOS KASSAPIDIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 04/19/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150-55 14TH AVENUE
WHITESTONE NY
11357
US

IV. Provider business mailing address

2121 31ST ST
ASTORIA NY
11105-2684
US

V. Phone/Fax

Practice location:
  • Phone: 718-559-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number190861
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number1908611
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: