Provider Demographics
NPI:1194823435
Name:KOTOV, ALEXANDER (NP)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:KOTOV
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9605 220TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-1347
Mailing Address - Country:US
Mailing Address - Phone:646-201-8985
Mailing Address - Fax:718-479-3781
Practice Address - Street 1:160 W 26TH ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6975
Practice Address - Country:US
Practice Address - Phone:212-924-2510
Practice Address - Fax:212-812-3800
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333427-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02177773Medicaid
NY02177773Medicaid