Provider Demographics
NPI:1568923696
Name:KOTHARI, DHVANI (MD)
Entity Type:Individual
Prefix:
First Name:DHVANI
Middle Name:
Last Name:KOTHARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TENTH AVENUE
Mailing Address - Street 2:DEPT. OF EMERGENCY MEDICINE RM GE-01
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:631-662-1282
Mailing Address - Fax:
Practice Address - Street 1:1000 TENTH AVENUE
Practice Address - Street 2:DEPT. OF EMERGENCY MEDICINE RM GE-01
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-523-8158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA11444200207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program