Organization
PURNIMA M. KOTHARI, PHYSICIAN, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PURNIMA M KOTHARI (PRESIDENT)
(516) 735-1116
Entity
Organization
Contact information
Practice address
54 HEATHER LN, LEVITTOWN, NY 11756-3334
(516) 735-1116
Mailing address
54 HEATHER LN, LEVITTOWN, NY 11756-3334
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
146056
NY
2080A0000X
Pediatric Adolescent Medicine Physician
204375
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00637605
—
NY
01
—
02005269
MEDICAID GROUP
NY
Enumeration date
05/15/2007
Last updated
01/25/2017
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