=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902851470
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY B. KOT AUD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2006
-----------------------------------------------------
Last Update Date | 05/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 453 CLIFTON AVE.
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-772-5457
-----------------------------------------------------
Fax | 973-772-5457
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 453 CLIFTON AVE.
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-772-5457
-----------------------------------------------------
Fax | 973-772-5457
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 25MG00040300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 41YA00010300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 231HA2400X
-----------------------------------------------------
Taxonomy Name | Assistive Technology Practitioner Audiologist
-----------------------------------------------------
License Number | 25MG00040300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------