1992787626 NPI number — STUART MARK KOTLER MD

Table of content: STUART MARK KOTLER MD (NPI 1992787626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992787626 NPI number — STUART MARK KOTLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOTLER
Provider First Name:
STUART
Provider Middle Name:
MARK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1992787626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
579A CRANBURY RD
Provider Second Line Business Mailing Address:
UNIVERSITY RADIOLOGY GROUP PC
Provider Business Mailing Address City Name:
EAST BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08816-5426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-390-0040
Provider Business Mailing Address Fax Number:
732-390-1856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
264 AMBOY AVE
Provider Second Line Business Practice Location Address:
UNIVERSITY RADIOLOGY GROUP PC
Provider Business Practice Location Address City Name:
METUCHEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08840-2441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-548-2322
Provider Business Practice Location Address Fax Number:
732-548-3392
Provider Enumeration Date:
11/17/2005

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: 2085R0202X , with the licence number:  25MA02697300 , 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: 00436553 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1812807 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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