Provider Demographics
NPI:1063678910
Name:ROTKOWITZ, LOUIS PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:PHILIP
Last Name:ROTKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104-20 QUEENS BLVD
Mailing Address - Street 2:APT. 12M
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3633
Mailing Address - Country:US
Mailing Address - Phone:518-578-3764
Mailing Address - Fax:518-213-0334
Practice Address - Street 1:104-20 QUEENS BLVD
Practice Address - Street 2:APT. 12M
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3633
Practice Address - Country:US
Practice Address - Phone:518-578-3764
Practice Address - Fax:518-213-0334
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251560207Q00000X
NY62532390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program