Provider Demographics
NPI:1073763637
Name:COTLER FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:COTLER FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:COTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-449-0914
Mailing Address - Street 1:1937 HIGHWAY 35
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3559
Mailing Address - Country:US
Mailing Address - Phone:732-449-0914
Mailing Address - Fax:732-449-5437
Practice Address - Street 1:1937 HIGHWAY 35
Practice Address - Street 2:SUITE 2
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3559
Practice Address - Country:US
Practice Address - Phone:732-449-0914
Practice Address - Fax:732-449-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB38353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC58381Medicare UPIN