Provider Demographics
NPI:1659355832
Name:COTLER, HAROLD MARK (DO)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:MARK
Last Name:COTLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:306 MONMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BRADLEY BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07720-1147
Mailing Address - Country:US
Mailing Address - Phone:732-449-0914
Mailing Address - Fax:732-449-5437
Practice Address - Street 1:1937 HWY 35
Practice Address - Street 2:SUITE 2
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3512
Practice Address - Country:US
Practice Address - Phone:732-449-0914
Practice Address - Fax:732-449-5437
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB38353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC58381Medicare UPIN
NJCO 667820Medicare ID - Type Unspecified