Healthcare Provider Details

I. General information

NPI: 1184211096
Provider Name (Legal Business Name): CHRISTINA KOTLYAR ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2020
Last Update Date: 12/26/2020
Certification Date: 12/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W MAIN ST
FREEHOLD NJ
07728-2549
US

IV. Provider business mailing address

4 HAZELWOOD CT
HOWELL NJ
07731-1611
US

V. Phone/Fax

Practice location:
  • Phone: 732-294-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01072100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: