Healthcare Provider Details

I. General information

NPI: 1306090782
Provider Name (Legal Business Name): MONIKA D KOTAPKA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 JERICHO TPKE
SYOSSET NY
11791-4515
US

IV. Provider business mailing address

972 BRUSH HOLLOW RD
WESTBURY NY
11590-1740
US

V. Phone/Fax

Practice location:
  • Phone: 516-496-2750
  • Fax: 516-496-6563
Mailing address:
  • Phone: 516-876-5555
  • Fax: 516-876-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number010704
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: