Provider Demographics
NPI:1376252627
Name:KOTKES, SOPHIA
Entity Type:Individual
Prefix:MISS
First Name:SOPHIA
Middle Name:
Last Name:KOTKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WEYANT DR
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2514
Mailing Address - Country:US
Mailing Address - Phone:516-320-9376
Mailing Address - Fax:
Practice Address - Street 1:45 WEYANT DR
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2514
Practice Address - Country:US
Practice Address - Phone:516-320-9376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist