Organization
KOTLYAR MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VITALY KOTLYAR MD (OWNER)
(917) 862-5558
Entity
Organization
Contact information
Practice address
369 LEXINGTON AVE RM 800, NEW YORK, NY 10017-6536
(631) 264-2030
(631) 264-1418
Mailing address
PO BOX 270, MASSAPEQUA PARK, NY 11762-0270
(631) 264-2035
(631) 264-1418
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
263221
NY
Other
Enumeration date
05/18/2017
Last updated
10/08/2019
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