Provider Demographics
NPI:1467887042
Name:PAN S KO, MD, PC
Entity Type:Organization
Organization Name:PAN S KO, MD, PC
Other - Org Name:SYLVAN INFECTIOUS DISEASES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-408-5314
Mailing Address - Street 1:400 SYLVAN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2729
Mailing Address - Country:US
Mailing Address - Phone:201-408-5314
Mailing Address - Fax:201-408-4431
Practice Address - Street 1:400 SYLVAN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2729
Practice Address - Country:US
Practice Address - Phone:201-408-5314
Practice Address - Fax:201-408-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08411400207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0430480Medicaid
NJ148588Medicare UPIN
NJ0430480Medicaid