Provider Demographics
NPI:1033504840
Name:KOTHAWAR, VEENA
Entity Type:Individual
Prefix:
First Name:VEENA
Middle Name:
Last Name:KOTHAWAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WATERSIDE PLZ APT 3F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2624
Mailing Address - Country:US
Mailing Address - Phone:609-815-9803
Mailing Address - Fax:
Practice Address - Street 1:30 WATERSIDE PLZ APT 3F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2624
Practice Address - Country:US
Practice Address - Phone:609-815-9803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026463001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice