Provider Demographics
NPI:1063540268
Name:HERSCHEL KOTKES MD PC
Entity type:Organization
Organization Name:HERSCHEL KOTKES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERSCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-295-2830
Mailing Address - Street 1:45 WEYANT DR
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2514
Mailing Address - Country:US
Mailing Address - Phone:516-295-2830
Mailing Address - Fax:
Practice Address - Street 1:222 ROCKAWAY TPKE STE 1
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1817
Practice Address - Country:US
Practice Address - Phone:516-295-2830
Practice Address - Fax:516-596-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221937208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty