Provider Demographics
NPI:1952498750
Name:KOTHARI, PURNIMA M (MD)
Entity Type:Individual
Prefix:DR
First Name:PURNIMA
Middle Name:M
Last Name:KOTHARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-1207
Mailing Address - Country:US
Mailing Address - Phone:718-436-4781
Mailing Address - Fax:718-871-8950
Practice Address - Street 1:4609 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-1207
Practice Address - Country:US
Practice Address - Phone:718-436-4781
Practice Address - Fax:718-871-8950
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1460562080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63054Medicare UPIN