Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 25MA09765100 | NJ |
N | 207RP1001X | Pulmonary Disease | 25MA09765100 | NJ |
NPI | 1073873956 |
---|---|
Provider Name | Nisha Suresh Kotecha |
First Address | Boston, MA 02241-6457 |
Second Address | Summit, NJ 07901-4055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2012 |
Last Update Date | 10/05/2016 |