Provider Demographics
NPI:1104067941
Name:LARRY TETSOTI MD LLC
Entity type:Organization
Organization Name:LARRY TETSOTI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TETSOTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-443-3603
Mailing Address - Street 1:23 BRIGHTON 11TH ST STE 601
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5308
Mailing Address - Country:US
Mailing Address - Phone:718-336-6166
Mailing Address - Fax:
Practice Address - Street 1:23 BRIGHTON 11TH ST STE 601
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5308
Practice Address - Country:US
Practice Address - Phone:718-336-6166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214196208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty