Provider Demographics
NPI:1336244300
Name:KOTECHA, NARENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:NARENDRA
Middle Name:
Last Name:KOTECHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLUMBIA STREET
Mailing Address - Street 2:STE 390
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-452-8730
Mailing Address - Fax:845-452-2406
Practice Address - Street 1:1081 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524
Practice Address - Country:US
Practice Address - Phone:845-896-8553
Practice Address - Fax:845-452-2406
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1637601208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00928249Medicaid
NY52D5310Medicare ID - Type Unspecified
A63111Medicare UPIN