Provider Demographics
NPI:1699881383
Name:PETER ROUVELAS, M.D., P.C.
Entity type:Organization
Organization Name:PETER ROUVELAS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUVELAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-897-6694
Mailing Address - Street 1:8115 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2804
Mailing Address - Country:US
Mailing Address - Phone:718-833-5303
Mailing Address - Fax:718-833-5304
Practice Address - Street 1:8115 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2804
Practice Address - Country:US
Practice Address - Phone:718-833-5303
Practice Address - Fax:718-833-5304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193878-1207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2325878OtherAETNA/USHC HMO INTERN MED
NY901308102OtherAMERI HEALTH
NY11N8621OtherNEIGHBORHOOD
NY202049OtherUSFHP
NY35285OtherMASTERCARE
NY161188OtherELDERPLAN
NY17J031OtherBLUE CROSS/BLUE SHIELD
NY1P0045OtherPHS
NY2327011OtherAETNA/USHC HMO CARDIOLOGY
NY6004974OtherGHI
NY7817826005OtherCIGNA
NY7969061OtherAETNA/USHC PPO/POS
NY00000093064OtherBETTER HEALTH PPO
NY01623541Medicaid
NY102998OtherAETNA/USCH (PCP ONLY)
NY193878-NYOther199 SEIU
NY1P0045OtherTOUCHSTONE
NYRP3878OtherATLANTIS
NY11N8621OtherNEIGHBORHOOD
NYF93918Medicare UPIN