Healthcare Provider Details

I. General information

NPI: 1306017843
Provider Name (Legal Business Name): RICHMOND HILL PHYSICIAN DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10152 LEFFERTS BLVD
SOUTH RICHMOND HILL NY
11419-2006
US

IV. Provider business mailing address

PO BOX 152
GLEN HEAD NY
11545-0152
US

V. Phone/Fax

Practice location:
  • Phone: 718-849-0404
  • Fax:
Mailing address:
  • Phone: 718-849-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHLEEN G. KOHUT
Title or Position: PRESIDENT
Credential: D.O.
Phone: 718-849-0404