Provider Demographics
NPI:1699870568
Name:KOKOTOS, FOTINI J (MD)
Entity type:Individual
Prefix:
First Name:FOTINI
Middle Name:J
Last Name:KOKOTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14626 25TH DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1418
Mailing Address - Country:US
Mailing Address - Phone:917-881-7291
Mailing Address - Fax:
Practice Address - Street 1:1111 PARK AVE
Practice Address - Street 2:PARK AVENUE PEDIATRICS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1234
Practice Address - Country:US
Practice Address - Phone:212-534-3000
Practice Address - Fax:212-996-8420
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198674208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0163323Medicaid
NYG16595Medicare UPIN
NY525201Medicare ID - Type Unspecified