1598758435 NPI number — DR. DONALD P KOTLER M.D.

Table of content: DR. DONALD P KOTLER M.D. (NPI 1598758435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598758435 NPI number — DR. DONALD P KOTLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOTLER
Provider First Name:
DONALD
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598758435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1790 BROADWAY
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10019-1412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-315-0144
Provider Business Mailing Address Fax Number:
212-315-0196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1090 AMSTERDAM AVE
Provider Second Line Business Practice Location Address:
4TH FL
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10025-1737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-961-5530
Provider Business Practice Location Address Fax Number:
212-531-7640
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  124445 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00409072 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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