Individual
DR. JOHN DEPETRILLO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10201 66TH RD, FOREST HILLS, NY 11375-2029
(718) 830-4359
(718) 830-1015
Mailing address
2249 35TH ST, APT 1, ASTORIA, NY 11105-2206
(516) 509-6501
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
250815-1
NY
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
250815
NY
207RI0200X
Infectious Disease Physician
250815-1
NY
Other
Enumeration date
05/23/2007
Last updated
09/02/2014
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