Healthcare Provider Details

I. General information

NPI: 1184021941
Provider Name (Legal Business Name): KOCHIN MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 E 7TH ST
BROOKLYN NY
11230-5103
US

IV. Provider business mailing address

1321 E 7TH ST
BROOKLYN NY
11230-5103
US

V. Phone/Fax

Practice location:
  • Phone: 718-338-1313
  • Fax: 718-338-7777
Mailing address:
  • Phone: 718-338-1313
  • Fax: 718-338-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number221100
License Number StateNY

VIII. Authorized Official

Name: ISRAEL KOCHIN
Title or Position: OWENER
Credential: MD
Phone: 718-338-1313