Healthcare Provider Details

I. General information

NPI: 1003923038
Provider Name (Legal Business Name): RICHARD E KOTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 N COUNTRY RD SUITE 301
PORT JEFFERSON NY
11777-2188
US

IV. Provider business mailing address

2800 MARCUS AVE PRO HEALTH CARE
NEW HYDE PARK NY
11042
US

V. Phone/Fax

Practice location:
  • Phone: 631-474-4200
  • Fax: 631-474-4202
Mailing address:
  • Phone: 516-622-6000
  • Fax: 516-622-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number188236
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: