Provider Demographics
NPI:1043310253
Name:FERAYDOON KOHAN, MD, LLC
Entity Type:Organization
Organization Name:FERAYDOON KOHAN, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERAYDOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-222-9900
Mailing Address - Street 1:PO BOX 220035
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11022-0035
Mailing Address - Country:US
Mailing Address - Phone:201-222-9900
Mailing Address - Fax:201-222-9929
Practice Address - Street 1:550 NEWARK AVE
Practice Address - Street 2:SUITE 301A
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1326
Practice Address - Country:US
Practice Address - Phone:201-222-9900
Practice Address - Fax:201-222-9929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06900200207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8763801Medicaid
NJ088283Medicare ID - Type Unspecified
NJ8763801Medicaid