Provider Demographics
NPI:1366889719
Name:KOTIAN, SUHAS S (PT)
Entity type:Individual
Prefix:
First Name:SUHAS
Middle Name:S
Last Name:KOTIAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 CLIFTON AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1900
Mailing Address - Country:US
Mailing Address - Phone:862-899-7900
Mailing Address - Fax:
Practice Address - Street 1:246 CLIFTON AVE STE 5
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1900
Practice Address - Country:US
Practice Address - Phone:862-899-7900
Practice Address - Fax:862-899-7901
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01785600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist