Healthcare Provider Details

I. General information

NPI: 1003878943
Provider Name (Legal Business Name): HARISH B KOTHARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 OAK TREE ROAD SUITE N
SOUTH PLAINFIELD NJ
07080-5127
US

IV. Provider business mailing address

906 OAK TREE ROAD SUITE N
SOUTH PLAINFIELD NJ
07080-5127
US

V. Phone/Fax

Practice location:
  • Phone: 908-412-6588
  • Fax: 908-412-6558
Mailing address:
  • Phone: 908-412-6588
  • Fax: 908-412-6558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number32711
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number131535
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: