Provider Demographics
NPI:1760410088
Name:KOHAN, DODIS (MD)
Entity Type:Individual
Prefix:
First Name:DODIS
Middle Name:
Last Name:KOHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 HAWKINS AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-2327
Mailing Address - Country:US
Mailing Address - Phone:631-676-7390
Mailing Address - Fax:631-676-7388
Practice Address - Street 1:11 DUMBARTON DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2468
Practice Address - Country:US
Practice Address - Phone:631-676-7390
Practice Address - Fax:631-676-7388
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148282207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790932309Medicare PIN
NYE65153Medicare UPIN
NY88F111Medicare ID - Type Unspecified