Renaissance OB/GYN, P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

193132 Issued in NY

Legal business name

RENAISSANCE OB/GYN, P.C.

Practice address

2747 Crescent St S
Suite 104
Astoria, NY 11102-3142

Phone

(718) 626-0887

Fax

(718) 626-0888

NPI assigned

Feb 5, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Pericles M Spyropoulos, M.D.NPI 1609971407

Title

President

Phone

(718) 777-7236

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pericles M Spyropoulos, M.D.

  • Obstetrics & Gynecology Physician
  • Astoria, NY
  • NPI 1609971407
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202169600000",
    "number": "1487832275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27-47 CRESCENT ST",
            "address_2": "SUITE 104",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "11102",
            "telephone_number": "718-626-0887",
            "fax_number": "718-626-0888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2747 CRESCENT ST S",
            "address_2": "SUITE 104",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111023142",
            "telephone_number": "718-626-0887",
            "fax_number": "718-626-0888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE OB/GYN, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-05",
        "last_updated": "2008-02-05",
        "status": "A",
        "authorized_official_last_name": "SPYROPOULOS",
        "authorized_official_first_name": "PERICLES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-777-7236",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "193132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01467032",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Astoria, NY
• Providers in Astoria, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.