Healthcare Provider Details

I. General information

NPI: 1346325230
Provider Name (Legal Business Name): NODAR KOZHIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6960 108TH ST SUITE 101
FOREST HILLS NY
11375-4323
US

IV. Provider business mailing address

6960 108TH ST SUITE 101
FOREST HILLS NY
11375-4323
US

V. Phone/Fax

Practice location:
  • Phone: 718-275-8200
  • Fax: 718-896-3166
Mailing address:
  • Phone: 718-275-8200
  • Fax: 718-896-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number139141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: