Provider Demographics
NPI:1821251968
Name:KOTHARI, GAUTAM HIMANSHU (DO)
Entity type:Individual
Prefix:DR
First Name:GAUTAM
Middle Name:HIMANSHU
Last Name:KOTHARI
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:609-267-9400
Mailing Address - Fax:609-424-3517
Practice Address - Street 1:243 US HIGHWAY 130 STE 100
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2137
Practice Address - Country:US
Practice Address - Phone:609-267-9400
Practice Address - Fax:609-424-3517
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08908900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ219952Medicare PIN