DR. GUSTAVO RAUL DEPETRIS (NPI# 1942226410) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942226410 |
| Entity Type | Individual |
| Full Name | DR. GUSTAVO RAUL DEPETRIS |
| Credential | MD |
| Practice Address |
2322 30th Ave 2nd Floor Astoria NY 11102-3255 |
| Practice Telephone | 7189567988 |
| Practice Fax Number | 7182671990 |
| Mailing Telephone | 7189567988 |
| Mailing Fax Number | 7182671990 |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 196792 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | LIC ID | 196792 | 01 |
| NY | 01630524 | 05 |
| Street Address |
2322 30TH AVE 2ND FLOOR |
| City | ASTORIA |
| State | NY |
| Zip Code | 11102-3255 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710939020 | Richard W Desmond | Internal Medicine | 2322 30th Ave, 2 Fl, Astoria, NY 11102-3255 | 2006-05-16 |
| 1962951970 | Ny Surgical | Surgery | 2322 30th Ave, Astoria, NY 11102-3255 | 2016-10-03 |
| 1528365699 | George John Tsioulias Medical, PC | Surgery | 2322 30th Ave, Astoria, NY 11102-3255 | 2011-02-24 |
| 1386768216 | Jill Schaeffer | Dietitian, Registered | 2322 30th Ave, Suite B, Astoria, NY 11102-3255 | 2007-03-17 |
| 1316005507 | Andrea Joy Schaeffer | Dietitian, Registered | 2322 30th Ave, 2nd Floor, Astoria, NY 11102-3255 | 2006-12-04 |
| 1679657688 | George John Tsioulias | Specialist | 2322 30th Ave, Astoria, NY 11102-3255 | 2006-10-25 |
| 1689783805 | Advanced Radiation Oncology Services of Queens | Radiology | 2322 30th Ave, Astoria, NY 11102-3255 | 2006-08-30 |
| 1639193345 | George Varsos | Radiology | 2322 30th Ave, Astoria, NY 11102-3255 | 2006-07-26 |
| 1538181656 | Rosina Dimoulas | Radiology | 2322 30th Ave, Astoria, NY 11102-3255 | 2006-07-25 |
| 1871531871 | Virgilio S Cepellos | Internal Medicine | 2322 30th Ave, 2nd Floor, Astoria, NY 11102-3255 | 2006-06-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497301444 | Stephanie Angela Van Rossem | Nurse Practitioner | 28-18 Astoria Blvd, Astoria, Ny 11102, Astoria, NY 11102 | 2019-08-15 |
| 1831754118 | Ahmed Mohamed Sayed Zedan | Pharmacist | 3014 14th St, Astoria, NY 11102 | 2019-05-02 |
| 1841758927 | Prohealth Care Associates, LLP | Occupational Therapist | 27-17 Cresecent Street, Suite 1, Astoria, NY 11102 | 2019-03-07 |
| 1598231292 | Mayuri Ardak | Student in an Organized Health Care Education/Training Program | 25-40 30th Road Suite A1, Astoria, NY 11102 | 2018-10-19 |
| 1134626740 | Claudia Ahumada, Lcsw, Pllc | Social Worker | 2556 31st St Ste 302, Astoria, NY 11102 | 2018-04-10 |
| 1255840039 | Ashley Taylor Curaba | Physician Assistant | 25-10 30th Rd, Queens, NY 11102 | 2017-09-25 |
| 1265953517 | Kathleen Yetman | Student in an Organized Health Care Education/Training Program | 2707 8th Street, The Astoria Blue Feather Profram, Astoria, NY 11102 | 2017-06-27 |
| 1679933998 | Tarek R Khater | Clinic/Center | 2814 31st St, Suite 501, Astoria, NY 11102 | 2016-02-29 |
| 1295194116 | Individualized Family Care LLC | Community/Behavioral Health | 12-22 30th Ave, Apt 4h, Astoria, NY 11102 | 2016-02-19 |
| 1700288909 | Andre Farah Dc PC | Chiropractor | 29-15 Astoria Blvd, Astoria, NY 11102 | 2014-09-18 |
| Find all providers in zip 11102 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639526858 | Emili Llazo | Internal Medicine | 2369 24th St # 2f, Astoria, NY 11105-3414 | 2016-05-17 |
| 1740619055 | Timothy Michael Becker | Internal Medicine | 2095 Exchange St Ste 301, Astoria, OR 97103-3400 | 2013-11-06 |
| 1891005922 | Irida Balili | Internal Medicine | 2311 33rd St, 2a, Astoria, NY 11105-2460 | 2010-10-07 |
| 1508198045 | Better Care, Inc | Internal Medicine | 25-92 Steinway Street, Astoria, NY 11103 | 2010-02-09 |
| 1659515302 | Melvina Patel | Internal Medicine | 4101 30th Ave, Astoria, NY 11103-2908 | 2009-04-25 |
| 1619110277 | Abdul Ali Khuwaja.physician PC | Internal Medicine | 45 05 Broadway, Astoria, NY 11103-1625 | 2009-04-13 |
| 1407094410 | Socrates Thomas Kangadis | Internal Medicine | 2309 31st St, Unit # 3, Astoria, NY 11105-2767 | 2009-01-29 |
| 1194978403 | Amita Toprani | Internal Medicine | 2407 19th St Apt 2r, Astoria, NY 11102-3442 | 2008-10-30 |
| 1124282694 | Ken Truong | Internal Medicine | 2322 Broadway, Astoria, NY 11106-4196 | 2008-07-15 |
| 1154583227 | Rita Shah | Internal Medicine | 3011 21st St Apt 5d, Astoria, NY 11102-2873 | 2008-06-30 |
| Find all providers in ASTORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.