Healthcare Provider Details

I. General information

NPI: 1568040913
Provider Name (Legal Business Name): JALAL KOJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 MAIN ST
PATERSON NJ
07503-3028
US

IV. Provider business mailing address

94 1ST ST
LODI NJ
07644-1086
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-2000
  • Fax:
Mailing address:
  • Phone: 201-749-6990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA12076200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: