1780603902 NPI number — CHRISTINE S KOTULSKI D.P.M.

Table of content: CHRISTINE S KOTULSKI D.P.M. (NPI 1780603902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780603902 NPI number — CHRISTINE S KOTULSKI D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOTULSKI
Provider First Name:
CHRISTINE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1780603902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52 BERLIN RD
Provider Second Line Business Mailing Address:
SUITE 5000
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08034-3574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-795-1003
Provider Business Mailing Address Fax Number:
856-795-5994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 BERLIN RD
Provider Second Line Business Practice Location Address:
SUITE 5000
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08034-3574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-795-1003
Provider Business Practice Location Address Fax Number:
856-795-5994
Provider Enumeration Date:
07/19/2006

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: 213E00000X , with the licence number:  25MD00266300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: SC005550 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2142511000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 188528 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8816701 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60000586 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3015106 . This is a "OXFORD INSURANCE" identifier . This identifiers is of the category "OTHER".




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