Provider Demographics
NPI:1093705683
Name:KOTLUS, BRETT SETH (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:SETH
Last Name:KOTLUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:20 E 66TH STREET
Mailing Address - Street 2:1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:212-882-1011
Mailing Address - Fax:646-751-8746
Practice Address - Street 1:20 E 66TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6531
Practice Address - Country:US
Practice Address - Phone:917-783-1199
Practice Address - Fax:646-751-8746
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY231319207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300111558Medicare PIN
AZ102995Medicare ID - Type Unspecified