Provider Demographics
NPI:1003289596
Name:LOFTS MEDICAL ASSOC NEW JERSEY PC
Entity Type:Organization
Organization Name:LOFTS MEDICAL ASSOC NEW JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKROO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-757-8100
Mailing Address - Street 1:2103 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3403
Mailing Address - Country:US
Mailing Address - Phone:609-586-4739
Mailing Address - Fax:609-588-5314
Practice Address - Street 1:2103 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3403
Practice Address - Country:US
Practice Address - Phone:609-586-4739
Practice Address - Fax:609-588-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ485350Medicare UPIN