Provider Demographics
NPI:1801061031
Name:LEELA KASTURI MD, PC.
Entity type:Organization
Organization Name:LEELA KASTURI MD, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEELAVATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:KASTURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-896-2710
Mailing Address - Street 1:10235 64TH RD
Mailing Address - Street 2:MEDICAL OFFICE
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1545
Mailing Address - Country:US
Mailing Address - Phone:718-896-2710
Mailing Address - Fax:
Practice Address - Street 1:10235 64TH RD
Practice Address - Street 2:MEDICAL OFFICE
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1545
Practice Address - Country:US
Practice Address - Phone:718-896-2710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182286207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty