Provider Demographics
NPI:1477961993
Name:KOTANKO, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KOTANKO
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 1:175 E 96TH ST
Mailing Address - Street 2:APT 21L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6200
Mailing Address - Country:US
Mailing Address - Phone:917-428-1957
Mailing Address - Fax:
Practice Address - Street 1:175 E 96TH ST
Practice Address - Street 2:APT 21L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6200
Practice Address - Country:US
Practice Address - Phone:917-428-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262949207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology