Individual provider Active NPI

Diana Koltovski, DO

  • Family Medicine Physician
  • Forest Hills, NY
National Provider Identifier
1225616683
Registry record updated Oct 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
332550 Issued in NY
Practice address
96-10 Metropolitan Ave
Forest Hills, NY 11375-6625
Phone
(718) 459-0400
Fax
(718) 670-6479
NPI assigned
Mar 29, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 332550 NY Primary

Addresses

Primary practice location

96-10 Metropolitan Ave
Forest Hills, NY 11375-6625

Mailing address

55 Water St FL 2
New York, NY 10041-0010
Phone (646) 680-2888

Other practice location 1

327 Beach 19th St
Far Rockaway, NY 11691-4423
Phone (718) 869-7108

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240923000283 NY Practitioner - Family Practice 4082155791 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advantagecare Physicians PCGroup PAC ID 2365735008, 307 clinicians

Practice addresses (Care Compare)

9610 Metropolitan Ave
Forest Hills, NY 11375-6625
Phone (718) 459-0400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
332550NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Advantagecare Physicians PC Family Medicine CurrentSince Sep 23, 2024 Accepting new patients
Advantagecare Physicians PC CurrentSince Sep 23, 2024 Accepting new patients

Locations

233 Nostrand Ave
Brooklyn, NY 11205
Phone (646) 680-1595

9610 Metropolitan Ave
Forest Hills, NY 11375
Phone (718) 459-0400

55 Water St
Fl 2
New York, NY 10041

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: dkoltovski54075@direct.acpny.com
  • FHIR API: https://epwebapps.acpny.com/FHIRproxy/ACPNY/api/FHIR/R4

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759363200000",
    "number": "1225616683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WATER ST FL 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100410010",
            "telephone_number": "646-680-2888",
            "fax_number": "516-542-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96-10 METROPOLITAN AVE",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113756625",
            "telephone_number": "718-459-0400",
            "fax_number": "718-670-6479"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "327 Beach 19th St",
            "address_purpose": "LOCATION",
            "city": "Far Rockaway",
            "state": "NY",
            "postal_code": "116914423",
            "country_code": "US",
            "telephone_number": "718-869-7108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOLTOVSKI",
        "first_name": "DIANA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-29",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "332550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

Verify at the official NPI Registry.