1265431332 NPI number — DR. ASHOKKUMAR J KOTHARI MD

Table of content: DR. ASHOKKUMAR J KOTHARI MD (NPI 1265431332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265431332 NPI number — DR. ASHOKKUMAR J KOTHARI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOTHARI
Provider First Name:
ASHOKKUMAR
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1265431332
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2223 W STATE ST
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
OLEAN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14760-1938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-373-3544
Provider Business Mailing Address Fax Number:
716-373-3546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2223 W STATE ST
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
OLEAN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14760-1938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-373-3544
Provider Business Practice Location Address Fax Number:
716-373-3546
Provider Enumeration Date:
07/20/2005

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: 207RC0000X , with the licence number:  NY149078-1 , 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: 00828313 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003691 . This is a "MEDICARE-ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2103703 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010094201 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000500369001 . This is a "BLUE CROSS NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000056493 . This is a "KEYSTONE BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 99007201 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".




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