MEDICARE: DR. NODAR KOZHIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	139141	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346325230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NODAR KOZHIN MD

Provider Business Mailing Address
First Line	:	6960 108TH ST
Second Line	:	SUITE 101
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4323
Country	:	US
Telephone Number	:	718-275-8200
Fax Number	:	718-896-3166

Provider Business Practice Location Address
First Line	:	6960 108TH ST
Second Line	:	SUITE 101
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4323
Country	:	US
Telephone Number	:	718-275-8200
Fax Number	:	718-896-3166

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	05/09/2008

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