Healthcare Provider Details

I. General information

NPI: 1942018973
Provider Name (Legal Business Name): CHIRAG KOTWAL LICENSED OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LILY CT
MONROE TOWNSHIP NJ
08831-5341
US

IV. Provider business mailing address

8 LILY CT
MONROE TOWNSHIP NJ
08831-5341
US

V. Phone/Fax

Practice location:
  • Phone: 732-589-9303
  • Fax:
Mailing address:
  • Phone: 732-589-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberTD0000404900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: