Healthcare Provider Details

I. General information

NPI: 1154050466
Provider Name (Legal Business Name): KIRTI CHAKOTE MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 VETERANS AVE STE 102
BROOKLYN NY
11234-5605
US

IV. Provider business mailing address

6410 VETERANS AVE STE 102
BROOKLYN NY
11234-5605
US

V. Phone/Fax

Practice location:
  • Phone: 718-763-7061
  • Fax: 718-763-3045
Mailing address:
  • Phone: 718-763-7061
  • Fax: 718-763-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number334510
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: