Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 250815-1 | NY |
N | 111NI0900X | Internist | 250815-1 | NY |
Y | 207RC0200X | Critical Care Medicine | 250815 | NY |
N | 207RI0200X | Infectious Disease | 250815-1 | NY |
NPI | 1013127562 |
---|---|
Provider Name | Dr. John Depetrillo JR. |
First Address | Astoria, NY 11105-2206 |
Second Address | Forest Hills, NY 11375-2029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 02/09/2014 |