Healthcare Provider Details

I. General information

NPI: 1639400849
Provider Name (Legal Business Name): ROBERT KOTRABA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 W 57TH ST STE 603
NEW YORK NY
10019
US

IV. Provider business mailing address

PO BOX 20571
NEW YORK NY
10023-1493
US

V. Phone/Fax

Practice location:
  • Phone: 212-757-1333
  • Fax: 212-757-6333
Mailing address:
  • Phone: 212-757-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number028976
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: