Provider Demographics
NPI:1750617593
Name:DANIEL KOHANSBY, O.D. PC
Entity type:Organization
Organization Name:DANIEL KOHANSBY, O.D. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHANSBY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-827-4120
Mailing Address - Street 1:418 ROUTE 23
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07416-2120
Mailing Address - Country:US
Mailing Address - Phone:973-827-4120
Mailing Address - Fax:973-827-0782
Practice Address - Street 1:418 ROUTE 23
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NJ
Practice Address - Zip Code:07416-2120
Practice Address - Country:US
Practice Address - Phone:973-827-4120
Practice Address - Fax:973-827-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00547900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7365403Medicaid
NJP2948830OtherOXFORD
NJ876391OtherAETNA
NJ114666OtherEYEMED
NJ1102568OtherCIGNA
NJ114666OtherEYEMED
NJU67264Medicare UPIN
NJ7365403Medicaid
NJ166708Medicare PIN
NJ876391OtherAETNA