Healthcare Provider Details

I. General information

NPI: 1336320308
Provider Name (Legal Business Name): JAMES P. KOTORAC, DC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 ROUTE 303
VALLEY COTTAGE NY
10989-2533
US

IV. Provider business mailing address

217 ROUTE 303
VALLEY COTTAGE NY
10989-2533
US

V. Phone/Fax

Practice location:
  • Phone: 845-268-8886
  • Fax: 845-268-0277
Mailing address:
  • Phone: 845-268-8886
  • Fax: 845-268-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX005083
License Number StateNY

VIII. Authorized Official

Name: JAMES P. KOTORAC
Title or Position: PRESIDENT
Credential: DC
Phone: 845-268-8886