Provider Demographics
NPI:1063594752
Name:KODSI, EHAB M (MD PHD)
Entity type:Individual
Prefix:
First Name:EHAB
Middle Name:M
Last Name:KODSI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804
Mailing Address - Country:US
Mailing Address - Phone:518-798-2225
Mailing Address - Fax:518-798-2807
Practice Address - Street 1:5 MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804
Practice Address - Country:US
Practice Address - Phone:518-798-2225
Practice Address - Fax:518-798-2807
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239223208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation