Individual
KOKILA MODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 EDGEWATER PLAZA, 1ST FL. LAB, STATEN ISLAND, NY 10305
(718) 226-4130
(718) 226-4185
Mailing address
1 EDGEWATER ST, 6TH FL. PAYER RELATIONS, STATEN ISLAND, NY 10305-4900
(718) 226-1008
(718) 226-1039
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
1136241
NY
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
113624
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220016392
RAILROAD MEDICARE
—
Enumeration date
03/08/2006
Last updated
05/08/2008
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