1659439644 NPI number — DR. KINNARI A KOTHARI M.D.

Table of content: DR. KINNARI A KOTHARI M.D. (NPI 1659439644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659439644 NPI number — DR. KINNARI A KOTHARI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOTHARI
Provider First Name:
KINNARI
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659439644
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BRITTON PL
Provider Second Line Business Mailing Address:
SUITE # 6
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-2514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-772-0700
Provider Business Mailing Address Fax Number:
856-864-0310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BRITTON PL
Provider Second Line Business Practice Location Address:
SUITE # 6
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-2514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-772-0700
Provider Business Practice Location Address Fax Number:
856-864-0310
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  25MA05442400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 050886 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 202304 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7534730 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3645687 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0445029000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0445029000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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