Individual
DR. GUSTAVO RAUL DEPETRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2322 30TH AVE, 2ND FLOOR, ASTORIA, NY 11102-3255
(718) 956-7988
(718) 267-1990
Mailing address
2322 30TH AVE, 2ND FLOOR, ASTORIA, NY 11102-3255
(718) 956-7988
(718) 267-1990
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
196792
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01630524
—
NY
01
—
196792
LIC ID
NY
Enumeration date
07/15/2006
Last updated
07/08/2007
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