Healthcare Provider Details

I. General information

NPI: 1104552447
Provider Name (Legal Business Name): ANDREW KOTCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 THE ALAMEDA
SAN JOSE CA
95126-1136
US

IV. Provider business mailing address

1813 EMERALD DR
OREFIELD PA
18069-9120
US

V. Phone/Fax

Practice location:
  • Phone: 408-261-7777
  • Fax: 408-259-2273
Mailing address:
  • Phone: 484-347-0839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: