1245243609 NPI number — DR. PETER ROUVELAS M.D.

Table of content: DR. PETER ROUVELAS M.D. (NPI 1245243609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245243609 NPI number — DR. PETER ROUVELAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROUVELAS
Provider First Name:
PETER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245243609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8115 7TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11228-2804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-833-5303
Provider Business Mailing Address Fax Number:
718-833-5304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8115 7TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11228-2804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-833-5303
Provider Business Practice Location Address Fax Number:
718-833-5304
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  193878-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 193878-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01623541 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 161188 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7969061 . This is a "AETNA/USHC PPO/POS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 102998 . This is a "AETNA/USHC (PCP ONLY)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 132698122 . This is a "U. HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1P0045 . This is a "TOUCHSTONE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2325878 . This is a "AETNA/USHC HMO INTERN.MED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2327011 . This is a "AETNA/USHC HMO CARDIOLOGY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1931221 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: RP3878 . This is a "ATLANTIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00000093064 . This is a "BETTER HEALTH PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1P0045 . This is a "PHS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7817826005 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11N8621 . This is a "NEIGHBORHOOD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 35285 . This is a "MASTERCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 901308102 . This is a "AMERI HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 17J031 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 202049 . This is a "USF HP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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