Healthcare Provider Details

I. General information

NPI: 1871739748
Provider Name (Legal Business Name): MOHY ELDIN A KOTB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2008
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36-42 NEWARK ST STE 302
HOBOKEN NJ
07030-5655
US

IV. Provider business mailing address

36-42 NEWARK ST STE 302
HOBOKEN NJ
07030-5655
US

V. Phone/Fax

Practice location:
  • Phone: 201-533-0222
  • Fax: 201-533-0223
Mailing address:
  • Phone: 201-533-0222
  • Fax: 201-533-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number25MA09556600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: