Healthcare Provider Details

I. General information

NPI: 1265431332
Provider Name (Legal Business Name): ASHOKKUMAR J KOTHARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 W STATE ST SUITE 120
OLEAN NY
14760-1938
US

IV. Provider business mailing address

2223 W STATE ST SUITE 120
OLEAN NY
14760-1938
US

V. Phone/Fax

Practice location:
  • Phone: 716-373-3544
  • Fax: 716-373-3546
Mailing address:
  • Phone: 716-373-3544
  • Fax: 716-373-3546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberNY149078-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00828313
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier003691
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMEDICARE-ID
# 3
Identifier2103703
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerINDEPENDENT HEALTH
# 4
Identifier00010094201
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerUNIVERA
# 5
Identifier000500369001
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerBLUE CROSS NY
# 6
Identifier000056493
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerKEYSTONE BLUE
# 7
Identifier99007201
Identifier TypeOTHER
Identifier State
Identifier IssuerRR MEDICARE PIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: