Provider Demographics
NPI:1710065925
Name:ITESCU, SILVIU (MD)
Entity Type:Individual
Prefix:
First Name:SILVIU
Middle Name:
Last Name:ITESCU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 FORT WASHINGTON AVE
Mailing Address - Street 2:7-453GN
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3733
Mailing Address - Country:US
Mailing Address - Phone:201-447-8717
Mailing Address - Fax:201-251-3300
Practice Address - Street 1:177 FORT WASHINGTON AVE
Practice Address - Street 2:7-453GN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3733
Practice Address - Country:US
Practice Address - Phone:201-447-8717
Practice Address - Fax:201-251-3300
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200495-1207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY345121Medicare ID - Type Unspecified
NYG26869Medicare UPIN