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General NPI Number Information
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NPI Number | 1801061031
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Entity Type | Organization
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Legal Business Name | LEELA KASTURI MD, PC.
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 10235 64TH RD MEDICAL OFFICE
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City | FOREST HILLS
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State | NY
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Zip | 11375-1545
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Country | US
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Telephone | 718-896-2710
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Fax |
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Provider Business Mailing Address
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Address Line | 10235 64TH RD MEDICAL OFFICE
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City | FOREST HILLS
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State | NY
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Zip | 11375-1545
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Country | US
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Telephone | 718-896-2710
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. LEELAVATHI KASTURI
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Credential | MD.
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Telephone | 718-896-2710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 182286
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License Number State | NY
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