Healthcare Provider Details

I. General information

NPI: 1306188321
Provider Name (Legal Business Name): NIRAJ ROHIT KOTHARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 98TH ST
NEW YORK NY
10029-6501
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL # 1118
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-4060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101265327
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number323672
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: