Provider Demographics
NPI:1649231184
Name:TSOUTSOURAS, STEVEN (MD, FAAP)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:TSOUTSOURAS
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14645 58TH RD
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5416
Mailing Address - Country:US
Mailing Address - Phone:718-359-5866
Mailing Address - Fax:178-359-4359
Practice Address - Street 1:14645 58TH RD
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5416
Practice Address - Country:US
Practice Address - Phone:718-359-5866
Practice Address - Fax:178-359-4359
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141825208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00609141Medicaid
NY204722183OtherTAX ID#
NY1714*01OtherIMMUNIZATION REGISTRY
NYB88595Medicare UPIN