Healthcare Provider Details

I. General information

NPI: 1366889719
Provider Name (Legal Business Name): SUHAS S KOTIAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 CLIFTON AVE STE 5
CLIFTON NJ
07011-1900
US

IV. Provider business mailing address

246 CLIFTON AVE STE 5
CLIFTON NJ
07011-1900
US

V. Phone/Fax

Practice location:
  • Phone: 862-899-7900
  • Fax: 862-899-7901
Mailing address:
  • Phone: 862-899-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01785600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: