Provider Demographics
NPI:1497874341
Name:KOTAN, JOAN M (RN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:KOTAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 NATHAN PL
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3225
Mailing Address - Country:US
Mailing Address - Phone:631-421-2062
Mailing Address - Fax:
Practice Address - Street 1:689 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-7501
Practice Address - Country:US
Practice Address - Phone:631-854-4400
Practice Address - Fax:631-854-4411
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217431-1163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)