Healthcare Provider Details

I. General information

NPI: 1962256263
Provider Name (Legal Business Name): MS. EVE MICHELLE KOTKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 KINDERKAMACK RD STE C2
WESTWOOD NJ
07675-3601
US

IV. Provider business mailing address

109 LINWOOD AVE
EMERSON NJ
07630-1875
US

V. Phone/Fax

Practice location:
  • Phone: 201-308-3921
  • Fax:
Mailing address:
  • Phone: 201-741-7985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00387000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: