Provider Demographics
NPI:1336320308
Name:JAMES P. KOTORAC, DC, PC
Entity Type:Organization
Organization Name:JAMES P. KOTORAC, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:KOTORAC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-268-8886
Mailing Address - Street 1:217 ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2533
Mailing Address - Country:US
Mailing Address - Phone:845-268-8886
Mailing Address - Fax:845-268-0277
Practice Address - Street 1:217 ROUTE 303
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2533
Practice Address - Country:US
Practice Address - Phone:845-268-8886
Practice Address - Fax:845-268-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWX2ZT1Medicare PIN
NYT71243Medicare UPIN