Provider Demographics
NPI:1659363174
Name:KOTHARI, RAJESH S (DO)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:S
Last Name:KOTHARI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:732-212-0060
Mailing Address - Fax:732-212-0061
Practice Address - Street 1:495 N 13TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1317
Practice Address - Country:US
Practice Address - Phone:973-268-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06966000207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ24956OtherUHP NON PAR #
NJ8806306Medicaid
NJ047023XZMMedicare PIN
NJ047023P7DMedicare PIN
NJH34500Medicare UPIN
NJ047023Medicare ID - Type Unspecified
NJ8806306Medicaid
NJ047023UXKMedicare PIN
NJ047023CLDMedicare PIN
NJ047023UWYMedicare PIN