MEDICARE: FOREST HILLS UROLOGY SURGERY SERVICES P.C.

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1700286929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREST HILLS UROLOGY SURGERY SERVICES P.C.

Provider Business Mailing Address
First Line	:	6902 AUSTIN ST STE 3
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4250
Country	:	US
Telephone Number	:	718-544-4443
Fax Number	:

Provider Business Practice Location Address
First Line	:	6902 AUSTIN ST STE 3
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4250
Country	:	US
Telephone Number	:	718-544-4443
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DIMITRI KESSARIS
Credential	:	M.D.
Telephone Number	:	718-544-4443

Provider Enumeration Date	:	08/25/2014
Last Update Date	:	08/25/2014

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