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General NPI Number Information
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NPI Number | 1770558397
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Entity Type | Individual
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Provider Name | SRINIVAS KESANAKURTHY M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 12508 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-2234
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Country | US
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Telephone | 646-335-2795
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Fax |
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Provider Business Mailing Address
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Address Line | 12508 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-2234
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Country | US
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Telephone | 718-581-8093
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Fax | 646-292-5135
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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 | 221556
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 221556
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 221556
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 221556
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License Number State | NY
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