Provider Demographics
NPI:1710979158
Name:KODSI, ROBERT EL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EL
Last Name:KODSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6010 BAY PARKWAY
Mailing Address - Street 2:SUITE 804
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:718-851-6767
Mailing Address - Fax:718-851-5807
Practice Address - Street 1:6010 BAY PARKWAY
Practice Address - Street 2:SUITE 804
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:718-851-6767
Practice Address - Fax:718-851-5807
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2015-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1942861207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01694706Medicaid
4C3181OtherHEALTHNET
6014232OtherGHI
G14140Medicare UPIN
NY01694706Medicaid