Healthcare Provider Details

I. General information

NPI: 1245765882
Provider Name (Legal Business Name): KOMAL KOTHARI MD,MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 FORT WASHINGTON AVE INTERNAL MEDICINE RESIDENCY OFFICE FLOOR 6, CENTER 12
NEW YORK NY
10032-3733
US

IV. Provider business mailing address

177 FORT WASHINGTON AVE INTERNAL MEDICINE RESIDENCY OFFICE FLOOR 6, CENTER 12
NEW YORK NY
10032-3733
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6262
  • Fax:
Mailing address:
  • Phone: 212-305-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number304597
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: