Individual
AVINASH A KOTHAVALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 DIAMOND HILL RD, SUMMIT MEDICAL GROUP, BERKELEY HEIGHTS, NJ 07922-2104
(908) 273-4300
(908) 673-7108
Mailing address
1 DIAMOND HILL RD, SUMMIT MEDICAL GROUP, BERKELEY HEIGHTS, NJ 07922-2104
(908) 273-4300
(908) 673-7108
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
25MA08075300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107783CP5
MEDICARE ID-TYPE UNSPECIFIED
NJ
05
—
2107562
—
MA
Enumeration date
06/02/2006
Last updated
09/24/2012
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