Provider Demographics
NPI:1619130358
Name:BOTER & KOZHIN OBSTETRICAL & GYNECOLOGICAL PC
Entity Type:Organization
Organization Name:BOTER & KOZHIN OBSTETRICAL & GYNECOLOGICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NODAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-275-8200
Mailing Address - Street 1:6960 108TH STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4323
Mailing Address - Country:US
Mailing Address - Phone:718-275-8200
Mailing Address - Fax:718-896-3166
Practice Address - Street 1:6960 108TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4323
Practice Address - Country:US
Practice Address - Phone:718-275-8200
Practice Address - Fax:718-896-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139141207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1825167Medicaid
NYB78637Medicare UPIN
NY1825167Medicaid