Healthcare Provider Details

I. General information

NPI: 1205574993
Provider Name (Legal Business Name): POMELO NJ PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EISENHOWER PKWY
ROSELAND NJ
07068-1032
US

IV. Provider business mailing address

4701 SANGAMORE RD STE N100
BETHESDA MD
20816-2558
US

V. Phone/Fax

Practice location:
  • Phone: 914-919-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ISABELLE VON KOHORN
Title or Position: PRESIDENT
Credential: MD PHD
Phone: 914-919-9200