Provider Demographics
NPI:1831134311
Name:KOHAN, FERAYDOON (MD)
Entity Type:Individual
Prefix:
First Name:FERAYDOON
Middle Name:
Last Name:KOHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06900200207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8763801Medicaid
088283Medicare ID - Type Unspecified
H55494Medicare UPIN