Healthcare Provider Details

I. General information

NPI: 1972773935
Provider Name (Legal Business Name): JAMES KO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 01/05/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ROCKWOOD PL STE 110
ENGLEWOOD NJ
07631-4959
US

IV. Provider business mailing address

25 ROCKWOOD PL STE 110
ENGLEWOOD NJ
07631-4959
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-5805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number25MA08498800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number25MA08498800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA08498800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: