Provider Demographics
NPI:1467483990
Name:COTLER, ALICE ZARA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:ZARA
Last Name:COTLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:ZARA
Other - Last Name:KLEIMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:307 S EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2739
Mailing Address - Country:US
Mailing Address - Phone:856-686-4300
Mailing Address - Fax:
Practice Address - Street 1:1202 LANGHORNE NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-710-2100
Practice Address - Fax:215-710-5861
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052356363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant