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General NPI Number Information
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NPI Number | 1821251968
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Entity Type | Individual
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Provider Name | GAUTAM HIMANSHU KOTHARI D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 243 US HIGHWAY 130 STE 100
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City | BORDENTOWN
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State | NJ
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Zip | 08505-2137
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Country | US
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Telephone | 609-267-9400
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Fax | 609-424-3517
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Provider Business Mailing Address
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Address Line | 301 LIPPINCOTT DR STE 410
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City | MARLTON
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State | NJ
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Zip | 08053-4197
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Country | US
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Telephone | 609-267-9400
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Fax | 609-424-3517
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 25MB08908900
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License Number State | NJ
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