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General NPI Number Information
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NPI Number | 1053412593
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Entity Type | Organization
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Legal Business Name | IRVIN L KOTKIN MD PC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 02/05/2010
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Provider Practice Location Address
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Address Line | 1 CISNEY AVE
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City | FLORAL PARK
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State | NY
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Zip | 11001-3249
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Country | US
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Telephone | 516-354-4045
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Fax | 516-354-4813
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Provider Business Mailing Address
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Address Line | 1 CISNEY AVE
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City | FLORAL PARK
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State | NY
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Zip | 11001
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Country | US
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Telephone | 516-354-4045
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Fax | 516-354-4813
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Authorized Official
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Title or Position | MD
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Name | IRVIN LEE KOTKIN
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Credential | MD
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Telephone | 516-354-4045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 1534311
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License Number State | NY
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