Organization
FAMILY HEALTH NURSE PRACTITIONER HOME VISITS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEXANDER KOTOV NP (MEDICAL DIRECTOR)
(646) 201-8985
Entity
Organization
Contact information
Practice address
9605 220TH ST, QUEENS VILLAGE, NY 11429-1347
(646) 201-8985
Mailing address
9605 220TH ST, QUEENS VILLAGE, NY 11429-1347
(646) 201-8985
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F333427-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02177773
—
NY
01
—
G100065207
MEDICARE PTAN
NY
Enumeration date
11/21/2009
Last updated
01/12/2016
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