Healthcare Provider Details

I. General information

NPI: 1780659219
Provider Name (Legal Business Name): CYNTHIA A KOCSIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 ROUTE 34 SUITE 304
WALL TOWNSHIP NJ
07727-1612
US

IV. Provider business mailing address

1451 ROUTE 34 SUITE 304
WALL TOWNSHIP NJ
07727-1612
US

V. Phone/Fax

Practice location:
  • Phone: 732-453-7200
  • Fax: 732-453-7277
Mailing address:
  • Phone: 732-453-7200
  • Fax: 732-453-7277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA05156400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: