Provider Demographics
NPI:1043202492
Name:KOHANSBY, DANIEL (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KOHANSBY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 US HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-4107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1236 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-4107
Practice Address - Country:US
Practice Address - Phone:908-454-9865
Practice Address - Fax:908-847-0248
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00547900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7365403Medicaid
NJ002279Medicare ID - Type Unspecified
NJ7365403Medicaid