Provider Demographics
NPI:1881077055
Name:SOTIRIOS T KEROS
Entity type:Organization
Organization Name:SOTIRIOS T KEROS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOTIRIOS
Authorized Official - Middle Name:TONY
Authorized Official - Last Name:KEROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-930-4738
Mailing Address - Street 1:425 E 63RD ST
Mailing Address - Street 2:APT. E12F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7804
Mailing Address - Country:US
Mailing Address - Phone:646-930-4738
Mailing Address - Fax:
Practice Address - Street 1:425 E 63RD ST
Practice Address - Street 2:APT. E12F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7804
Practice Address - Country:US
Practice Address - Phone:646-930-4738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252777-1246ZE0500X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty