Healthcare Provider Details

I. General information

NPI: 1194823435
Provider Name (Legal Business Name): ALEXANDER KOTOV NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/27/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W 26TH ST FL 4
NEW YORK NY
10001-6975
US

IV. Provider business mailing address

9605 220TH ST
QUEENS VILLAGE NY
11429-1347
US

V. Phone/Fax

Practice location:
  • Phone: 212-924-2510
  • Fax: 212-812-3800
Mailing address:
  • Phone: 646-201-8985
  • Fax: 718-479-3781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF333427-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: