Provider Demographics
NPI:1053618371
Name:KOTOWICZ, PAULINA
Entity type:Individual
Prefix:
First Name:PAULINA
Middle Name:
Last Name:KOTOWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-1536
Mailing Address - Country:US
Mailing Address - Phone:732-541-2233
Mailing Address - Fax:732-541-2237
Practice Address - Street 1:1175 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-1536
Practice Address - Country:US
Practice Address - Phone:732-541-2233
Practice Address - Fax:732-541-2237
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01320600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist