Provider Demographics
NPI:1598805251
Name:KOTKIN, MICHAEL M (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:KOTKIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GLEN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2858
Mailing Address - Country:US
Mailing Address - Phone:516-676-1116
Mailing Address - Fax:516-676-2710
Practice Address - Street 1:70 GLEN ST STE 300
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542
Practice Address - Country:US
Practice Address - Phone:516-676-1116
Practice Address - Fax:516-676-2710
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003255213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T93427Medicare UPIN
NYPPWZ41Medicare PIN