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NPI Code Detail

MEDICARE: THOMAS LEON MITCHELL SKURTU AGPCNP-BC

MEDICARE: THOMAS LEON MITCHELL SKURTU AGPCNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner309800NY

General Provider Information

NPI Number : 1417554940
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS LEON MITCHELL SKURTU AGPCNP-BC
Provider Business Mailing Address
First Line : 477 84TH ST UNIT 2
Second Line :
City : BROOKLYN
State : NY
Zip : 11209-4711
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 170 BUFFALO AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11213-2421
Country : US
Telephone Number : 718-252-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2020
Last Update Date : 10/07/2020

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