Healthcare Provider Details

I. General information

NPI: 1871024505
Provider Name (Legal Business Name): JEFFREY ROBERT KOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 05/01/2024
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 N COUNTRY RD
PORT JEFFERSON NY
11777-2119
US

IV. Provider business mailing address

178 HARBOR RD
STONY BROOK NY
11790-2006
US

V. Phone/Fax

Practice location:
  • Phone: 631-473-1320
  • Fax:
Mailing address:
  • Phone: 201-602-7341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number303743-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number303743-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: