Individual
MS. LARA KOTHARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
249 FRANKLIN AVE, NUTLEY, NJ 07110-2710
(973) 542-1106
Mailing address
91 POPLAR DR, CEDAR KNOLLS, NJ 07927-1542
(973) 216-2348
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA052233
PA
Other
Enumeration date
06/12/2006
Last updated
07/08/2007
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