Healthcare Provider Details

I. General information

NPI: 1477867968
Provider Name (Legal Business Name): MRS. MARGARET W. KOTARY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N. WASHINGTON ST. SUITE 2470
HERKIMER NY
13350-2905
US

IV. Provider business mailing address

301 N. WASHINGTON ST. SUITE 2470
HERKIMER NY
13350-2905
US

V. Phone/Fax

Practice location:
  • Phone: 315-867-1465
  • Fax: 315-867-1469
Mailing address:
  • Phone: 315-867-1465
  • Fax: 315-867-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number253748-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: