MEDICARE: DR. PURNIMA M KOTHARI 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	2080A0000X	Pediatric Adolescent Medicine Physician	146056	NY

General Provider Information

NPI Number	:	1952498750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PURNIMA M KOTHARI MD

Provider Business Mailing Address
First Line	:	4609 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1207
Country	:	US
Telephone Number	:	718-436-4781
Fax Number	:	718-871-8950

Provider Business Practice Location Address
First Line	:	4609 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1207
Country	:	US
Telephone Number	:	718-436-4781
Fax Number	:	718-871-8950

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	06/05/2020

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