Healthcare Provider Details

I. General information

NPI: 1902851470
Provider Name (Legal Business Name): JEFFREY B. KOT AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 CLIFTON AVE.
CLIFTON NJ
07011
US

IV. Provider business mailing address

453 CLIFTON AVE.
CLIFTON NJ
07011
US

V. Phone/Fax

Practice location:
  • Phone: 973-772-5457
  • Fax: 973-772-5457
Mailing address:
  • Phone: 973-772-5457
  • Fax: 973-772-5457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number25MG00040300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number41YA00010300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number25MG00040300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: