# PETER PATETSIOS MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427500891
- **Authorized official:** PETER PATETSIOS MD (OWNER)
- **Authorized official phone:** (516) 570-6818

## Contact information

- **Practice address:** 900 NORTHERN BLVD, SUITE 140, GREAT NECK, NY 11021-5337
- **Practice address phone:** (516) 570-6818
- **Mailing address:** 900 NORTHERN BLVD, SUITE 140, GREAT NECK, NY 11021-5337
- **Mailing address phone:** (516) 570-6818

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/01/2016
- **Last updated:** 11/23/2016