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General NPI Number Information
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NPI Number | 1699262972
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Entity Type | Individual
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Provider Name | JUSTIN KOTLIAR MD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2018
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 1 CAPITAL WAY
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City | PENNINGTON
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State | NJ
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Zip | 08534-2520
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Country | US
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Telephone | 800-637-2374
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FEDERAL ST STE 200
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City | CAMDEN
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State | NJ
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Zip | 08103-1088
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Country | US
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Telephone | 848-288-6935
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 25MA12259500
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License Number State | NJ
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