Provider Demographics
NPI:1326032012
Name:KOHLI, RATTANJIT S (MD)
Entity Type:Individual
Prefix:DR
First Name:RATTANJIT
Middle Name:S
Last Name:KOHLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TULIP CT
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1045
Mailing Address - Country:US
Mailing Address - Phone:516-782-2530
Mailing Address - Fax:516-621-5950
Practice Address - Street 1:1220 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3832
Practice Address - Country:US
Practice Address - Phone:718-996-8388
Practice Address - Fax:718-540-4923
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186126-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01336841Medicaid
NY18G012Medicare ID - Type Unspecified
NY01336841Medicaid