MEDICARE: SIMON KADOSH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	25MA13063300	NJ

General Provider Information

NPI Number	:	1902593999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMON KADOSH MD

Provider Business Mailing Address
First Line	:	2290 W COUNTY LINE RD
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2290 W COUNTY LINE RD
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2267
Country	:	US
Telephone Number	:	732-645-9988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2023
Last Update Date	:	07/01/2026

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