Healthcare Provider Details

I. General information

NPI: 1598142523
Provider Name (Legal Business Name): SAMANTHA LEIGH COTLER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1937 ROUTE 35
WALL TOWNSHIP NJ
07719
US

IV. Provider business mailing address

271 GROVE AVE STE E
VERONA NJ
07044-1730
US

V. Phone/Fax

Practice location:
  • Phone: 732-449-0914
  • Fax: 732-449-5437
Mailing address:
  • Phone: 973-559-3700
  • Fax: 833-484-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB10614700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS14202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: