Provider Demographics
NPI:1003878943
Name:KOTHARI, HARISH B (MD)
Entity Type:Individual
Prefix:
First Name:HARISH
Middle Name:B
Last Name:KOTHARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 OAK TREE ROAD
Mailing Address - Street 2:SUITE N
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5127
Mailing Address - Country:US
Mailing Address - Phone:908-412-6588
Mailing Address - Fax:908-412-6558
Practice Address - Street 1:906 OAK TREE ROAD
Practice Address - Street 2:SUITE N
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5127
Practice Address - Country:US
Practice Address - Phone:908-412-6588
Practice Address - Fax:908-412-6558
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ32711207KA0200X
NY131535207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08899Medicare UPIN
022736Medicare ID - Type Unspecified