Provider Demographics
NPI:1780603902
Name:KOTULSKI, CHRISTINE S (DPM)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:S
Last Name:KOTULSKI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BERLIN RD
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3574
Mailing Address - Country:US
Mailing Address - Phone:856-795-1003
Mailing Address - Fax:856-795-5994
Practice Address - Street 1:52 BERLIN RD
Practice Address - Street 2:SUITE 5000
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3574
Practice Address - Country:US
Practice Address - Phone:856-795-1003
Practice Address - Fax:856-795-5994
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00266300213E00000X
PASC005550213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142511000OtherAMERIHEALTH
NJ188528OtherAMERIGROUP
NJ8816701Medicaid
NJ60000586OtherHORIZON NJ HEALTH
P3015106OtherOXFORD INSURANCE
NJ054726AL1Medicare PIN
NJ188528OtherAMERIGROUP
2142511000OtherAMERIHEALTH
U88718Medicare UPIN