Basic Information
| Provider Information | |||||||||
| NPI: | 1013127562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEPETRILLO | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2249 35TH ST | ||||||||
| Address2: | APT 1 | ||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111052206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165096501 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10201 66TH RD | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113752029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188304359 | ||||||||
| FaxNumber: | 7188301015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 09/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 250815-1 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 250815-1 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RC0200X | 250815 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.