Healthcare Provider Details

I. General information

NPI: 1588007439
Provider Name (Legal Business Name): KIMBERLY KOWALIK COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 ROUTE 17A
FLORIDA NY
10921
US

IV. Provider business mailing address

1751 ROUTE 17A
FLORIDA NY
10921-1525
US

V. Phone/Fax

Practice location:
  • Phone: 845-651-2251
  • Fax:
Mailing address:
  • Phone: 845-651-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number008244-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: