Healthcare Provider Details

I. General information

NPI: 1104270479
Provider Name (Legal Business Name): MARTIN KOTLAR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 W END AVE
NEW YORK NY
10024-4351
US

IV. Provider business mailing address

1245 GINGER CIR
WESTON FL
33326-3630
US

V. Phone/Fax

Practice location:
  • Phone: 212-496-0101
  • Fax:
Mailing address:
  • Phone: 954-389-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3481
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: