Healthcare Provider Details

I. General information

NPI: 1588630123
Provider Name (Legal Business Name): LAURIE M KOTOWSKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CHANDLER AVE
BATAVIA NY
14020-1611
US

IV. Provider business mailing address

33 CHANDLER AVE
BATAVIA NY
14020-1611
US

V. Phone/Fax

Practice location:
  • Phone: 585-343-9676
  • Fax: 585-343-1047
Mailing address:
  • Phone: 585-343-9676
  • Fax: 585-343-1047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number010000-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: