Healthcare Provider Details

I. General information

NPI: 1902130131
Provider Name (Legal Business Name): DAVID MICHAEL KOTERWAS N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE RM 345A NYU/BELLEVUE HOSPITAL CENTER
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

462 1ST AVE RM 345A NYU/BELLEVUE HOSPITAL CENTER
NEW YORK NY
10016-9196
US

V. Phone/Fax

Practice location:
  • Phone: 415-308-6117
  • Fax:
Mailing address:
  • Phone: 415-308-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17790
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF430549-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: