Healthcare Provider Details

I. General information

NPI: 1457537359
Provider Name (Legal Business Name): MR. MANOJ RATILAL KOTHARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 8TH AVE
NEW YORK NY
10036-7011
US

IV. Provider business mailing address

771 8TH AVE
NEW YORK NY
10036-7011
US

V. Phone/Fax

Practice location:
  • Phone: 212-974-6013
  • Fax:
Mailing address:
  • Phone: 212-974-6013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033389
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01927200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: