Provider Demographics
NPI:1588620199
Name:CO, JOHN ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALEXANDER
Last Name:CO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:140 CHESTNUT ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-445-0405
Mailing Address - Fax:201-445-4282
Practice Address - Street 1:140 CHESTNUT ST
Practice Address - Street 2:SUITE 202
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2599
Practice Address - Country:US
Practice Address - Phone:201-445-0405
Practice Address - Fax:201-445-4282
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2012-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA52567207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3344401Medicaid
NJ3344401Medicaid
NJC0605263Medicare ID - Type Unspecified