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General NPI Number Information
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NPI Number | 1679647465
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Entity Type | Individual
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Provider Name | THOMAS N KOUTELOS INTERNAL MEDICINE
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 25 PLAZA ST W STE 1F 421 78TH STREET BROOKLYN NY 11209
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City | BROOKLYN
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State | NY
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Zip | 11217-3942
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Country | US
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Telephone | 718-622-1025
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Fax | 718-622-0915
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Provider Business Mailing Address
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Address Line | 25 PLAZA ST W STE 1F 421 78TH STREET BROOKLYN NY 11209
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City | BROOKLYN
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State | NY
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Zip | 11217-3942
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Country | US
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Telephone | 718-622-1025
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Fax | 718-622-0915
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 19052 1
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License Number State | NY
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