Healthcare Provider Details

I. General information

NPI: 1659786135
Provider Name (Legal Business Name): NAA-DEI KOTEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 COLUMBUS AVE INTERNAL MEDICINE
NEW HAVEN CT
06519-1233
US

IV. Provider business mailing address

400 COLUMBUS AVE CREDENTIALING
NEW HAVEN CT
06519-1233
US

V. Phone/Fax

Practice location:
  • Phone: 203-503-3000
  • Fax: 203-503-3224
Mailing address:
  • Phone: 203-503-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number270420
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number67335
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: