Provider Demographics
NPI:1518190305
Name:RAOUF KODSY PHYSICIAN PC
Entity Type:Organization
Organization Name:RAOUF KODSY PHYSICIAN PC
Other - Org Name:NURSING HOME SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAOUF
Authorized Official - Middle Name:
Authorized Official - Last Name:KODSY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-736-0155
Mailing Address - Street 1:1644 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5428
Mailing Address - Country:US
Mailing Address - Phone:315-736-0155
Mailing Address - Fax:315-732-0393
Practice Address - Street 1:1644 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5428
Practice Address - Country:US
Practice Address - Phone:315-736-0155
Practice Address - Fax:315-732-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200560207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty