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General NPI Number Information
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NPI Number | 1710193024
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Entity Type | Organization
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Legal Business Name | PURNIMA M. KOTHARI, PHYSICIAN, PC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 54 HEATHER LN
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City | LEVITTOWN
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State | NY
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Zip | 11756-3334
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Country | US
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Telephone | 516-735-1116
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Fax |
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Provider Business Mailing Address
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Address Line | 54 HEATHER LN
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City | LEVITTOWN
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State | NY
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Zip | 11756-3334
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PURNIMA M KOTHARI
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Credential |
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Telephone | 516-735-1116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 204375
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 146056
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License Number State | NY
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