Provider Demographics
NPI:1255669552
Name:KOTELNICKI, JOSEPH J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:J
Last Name:KOTELNICKI
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:24 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-499-6600
Mailing Address - Fax:413-442-0744
Practice Address - Street 1:24 PARK STREET
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-499-6600
Practice Address - Fax:413-442-0744
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1727363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical