Healthcare Provider Details

I. General information

NPI: 1972227395
Provider Name (Legal Business Name): ESTHER KOTH MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 WALLABOUT ST APT 3F
BROOKLYN NY
11206-4361
US

IV. Provider business mailing address

285 WALLABOUT ST APT 3F
BROOKLYN NY
11206-4361
US

V. Phone/Fax

Practice location:
  • Phone: 718-486-0790
  • Fax:
Mailing address:
  • Phone: 718-486-0790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: