Healthcare Provider Details

I. General information

NPI: 1366599110
Provider Name (Legal Business Name): REBECCA KOBOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 WASHINGTON AVE
ALBANY NY
12222-0100
US

IV. Provider business mailing address

1400 WASHINGTON AVE
ALBANY NY
12222-0100
US

V. Phone/Fax

Practice location:
  • Phone: 518-442-5455
  • Fax:
Mailing address:
  • Phone: 518-442-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number215264
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: