Healthcare Provider Details

I. General information

NPI: 1437492774
Provider Name (Legal Business Name): SEAN AARON KOTKIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 CRANBURY RD STE 2
EAST BRUNSWICK NJ
08816-4093
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL # 1030
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 732-390-3333
  • Fax:
Mailing address:
  • Phone: 212-241-3871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number277699
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA12566200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: