Healthcare Provider Details

I. General information

NPI: 1790099570
Provider Name (Legal Business Name): VINIT KOTHEKAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 FLANAGAN WAY
SECAUCUS NJ
07094-3445
US

IV. Provider business mailing address

3027 JOHN F KENNEDY BLVD APT 51
JERSEY CITY NJ
07306-3665
US

V. Phone/Fax

Practice location:
  • Phone: 201-319-0010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number032434
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: