Healthcare Provider Details

I. General information

NPI: 1679969950
Provider Name (Legal Business Name): HARRISON COTLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 MONMOUTH RD
OAKHURST NJ
07755-1515
US

IV. Provider business mailing address

255 MONMOUTH RD
OAKHURST NJ
07755-1515
US

V. Phone/Fax

Practice location:
  • Phone: 908-489-8858
  • Fax:
Mailing address:
  • Phone: 732-531-5445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MB10777300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: