Healthcare Provider Details

I. General information

NPI: 1194881607
Provider Name (Legal Business Name): MICHAEL J. KOTCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 N WOOD AVE
LINDEN NJ
07036-3737
US

IV. Provider business mailing address

1905 N WOOD AVE
LINDEN NJ
07036-3737
US

V. Phone/Fax

Practice location:
  • Phone: 908-925-2020
  • Fax: 908-925-3373
Mailing address:
  • Phone: 908-925-2020
  • Fax: 908-925-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMA39029
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: