Provider Demographics
NPI:1417145897
Name:RATTANJIT S KOHLI PHYSICIAN PC
Entity Type:Organization
Organization Name:RATTANJIT S KOHLI PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RATTANJIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-782-2530
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:516-621-5950
Mailing Address - Fax:516-621-5950
Practice Address - Street 1:443 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2821
Practice Address - Country:US
Practice Address - Phone:718-282-6333
Practice Address - Fax:718-756-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01336841Medicaid