Provider Demographics
NPI:1568878593
Name:DR JESSE CONTOVASILIS MD PC
Entity Type:Organization
Organization Name:DR JESSE CONTOVASILIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTOVASILIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-357-0006
Mailing Address - Street 1:32 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-1530
Mailing Address - Country:US
Mailing Address - Phone:631-357-0006
Mailing Address - Fax:
Practice Address - Street 1:755 PARK AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3975
Practice Address - Country:US
Practice Address - Phone:631-357-0006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2732712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty