Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 25MA08411400 | NJ |
NPI | 1083851687 |
---|---|
Provider Name | Dr. Pan Sok Ko |
First Address | Englewood Cliffs, NJ 07632-2729 |
Second Address | Englewood Cliffs, NJ 07632-2729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2009 |
Last Update Date | 05/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0190756 | (05) | NJ |
0430480 | (05) | NJ |