Healthcare Provider Details

I. General information

NPI: 1215715776
Provider Name (Legal Business Name): NATALIA KOTOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1379 W 7TH ST
BROOKLYN NY
11204-4804
US

IV. Provider business mailing address

1859 80TH ST APT 3
BROOKLYN NY
11214-1792
US

V. Phone/Fax

Practice location:
  • Phone: 212-202-0765
  • Fax:
Mailing address:
  • Phone: 212-202-0765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF404777-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: