MEDICARE: INTERBORO HEART & VASCULAR PLLC

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
1	207R00000X	Internal Medicine Physician
2	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1770558397	OTHER		NPPES

General Provider Information

NPI Number	:	1609381458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERBORO HEART & VASCULAR PLLC

Provider Business Mailing Address
First Line	:	2825 3RD AVE STE 201
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-4066
Country	:	US
Telephone Number	:	718-887-7171
Fax Number	:	929-990-2928

Provider Business Practice Location Address
First Line	:	2825 3RD AVE STE 201
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-4066
Country	:	US
Telephone Number	:	718-887-7171
Fax Number	:	929-990-2928

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SRINIVAS KESANAKURTHY
Credential	:	MD
Telephone Number	:	718-887-7171

Provider Enumeration Date	:	12/01/2017
Last Update Date	:	04/27/2026

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