Provider Demographics
NPI:1417976408
Name:KODROFF, KURT STUART (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:STUART
Last Name:KODROFF
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 1:180 MONTAGUE ST
Mailing Address - Street 2:APARTMENT #3G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3607
Mailing Address - Country:US
Mailing Address - Phone:347-529-5059
Mailing Address - Fax:718-228-6954
Practice Address - Street 1:585 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1822
Practice Address - Country:US
Practice Address - Phone:718-604-5789
Practice Address - Fax:718-604-5527
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210374207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01878293Medicaid
NY16B131Medicare PIN
NY01878293Medicaid