Healthcare Provider Details

I. General information

NPI: 1659439644
Provider Name (Legal Business Name): KINNARI A KOTHARI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRITTON PL SUITE # 6
VOORHEES NJ
08043-2514
US

IV. Provider business mailing address

1 BRITTON PL SUITE # 6
VOORHEES NJ
08043-2514
US

V. Phone/Fax

Practice location:
  • Phone: 856-772-0700
  • Fax: 856-864-0310
Mailing address:
  • Phone: 856-772-0700
  • Fax: 856-864-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA05442400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: