Healthcare Provider Details

I. General information

NPI: 1447221288
Provider Name (Legal Business Name): SAMER KOTTIECH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 177TH ST APT 1
NEW YORK NY
10033-7152
US

IV. Provider business mailing address

601 W 177TH ST APT 1
NEW YORK NY
10033-7152
US

V. Phone/Fax

Practice location:
  • Phone: 917-453-0744
  • Fax: 646-852-6408
Mailing address:
  • Phone: 917-453-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number246854
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: