Physician Compare National (NPI:1396960043)

HEALTHCARE PROVIDER: BON CHANG A. KOO MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1396960043
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9830282730
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20130712000544
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KOO
	Individual professional last name
Provider First Name	BON CHANG
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NEW YORK UNIVERSITY MEDICAL COLLEGE - NLG
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	GASTROENTEROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MPV NEW JERSEY MD SERVICES PC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	5991097669
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	101
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1 W RIDGEWOOD AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 301
	Group Practice or individual's line 2 address
City	PARAMUS
	Group Practice or individual's city
State	NJ
	Group Practice or individual's state
Zip Code	076622350
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2014451660
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	310130
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HACKENSACK MERIDIAN HEALTH PASCACK VALLEY MEDICAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	310012
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	VALLEY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y