Healthcare Provider Details

I. General information

NPI: 1427050970
Provider Name (Legal Business Name): HERSCHEL KOTKES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 GRAND CANAL DR STE 102
MIAMI FL
33144-2566
US

IV. Provider business mailing address

45 WEYANT DR
CEDARHURST NY
11516-2514
US

V. Phone/Fax

Practice location:
  • Phone: 786-360-6655
  • Fax:
Mailing address:
  • Phone: 212-537-6380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number221937-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number161979
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number221937
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: