Healthcare Provider Details

I. General information

NPI: 1528591179
Provider Name (Legal Business Name): EDWARD VALERY KOGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 MOUNT PLEASANT AVE STE 102
WEST ORANGE NJ
07052-2751
US

IV. Provider business mailing address

375 MOUNT PLEASANT AVE STE 102
WEST ORANGE NJ
07052-2751
US

V. Phone/Fax

Practice location:
  • Phone: 973-731-9442
  • Fax:
Mailing address:
  • Phone: 973-731-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number25MA12722900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: