Provider Demographics
NPI:1598729196
Name:KOTOK, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:KOTOK
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 1:222 ALEXANDER ST
Mailing Address - Street 2:SUITE 4100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-4039
Mailing Address - Country:US
Mailing Address - Phone:585-922-8225
Mailing Address - Fax:585-922-8260
Practice Address - Street 1:222 ALEXANDER ST
Practice Address - Street 2:SUITE 4100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-4039
Practice Address - Country:US
Practice Address - Phone:585-922-8225
Practice Address - Fax:585-922-8260
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112748208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01684582Medicaid
NYCC6191Medicare ID - Type Unspecified
NYB72246Medicare UPIN