Provider Demographics
NPI:1346325230
Name:KOZHIN, NODAR (MD)
Entity Type:Individual
Prefix:DR
First Name:NODAR
Middle Name:
Last Name:KOZHIN
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 1:6960 108TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4323
Mailing Address - Country:US
Mailing Address - Phone:718-275-8200
Mailing Address - Fax:718-896-3166
Practice Address - Street 1:6960 108TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4323
Practice Address - Country:US
Practice Address - Phone:718-275-8200
Practice Address - Fax:718-896-3166
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139141207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1825167Medicaid
NY76462Medicare PIN
NYB78637Medicare UPIN