Provider Demographics
NPI:1699812305
Name:KOTHARY, PARESH (MD)
Entity Type:Individual
Prefix:DR
First Name:PARESH
Middle Name:
Last Name:KOTHARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:158 W 27TH ST
Mailing Address - Street 2:11TH FL. SOUTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6216
Mailing Address - Country:US
Mailing Address - Phone:212-563-2497
Mailing Address - Fax:212-563-0605
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:4TH FL. CHC BLDG
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5842
Practice Address - Fax:718-485-6370
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1460112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01137535Medicaid
NYA60757Medicare UPIN
NY15D711Medicare ID - Type UnspecifiedMEDICARE