Provider Demographics
NPI:1679548234
Name:KOH, ELSIE (MD)
Entity type:Individual
Prefix:
First Name:ELSIE
Middle Name:
Last Name:KOH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 VALLEY STREAM PKWY STE 100
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT.
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1407
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:610-644-8909
Practice Address - Street 1:1225 MCBRIDE AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-3812
Practice Address - Country:US
Practice Address - Phone:973-837-1018
Practice Address - Fax:973-837-1329
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA075460002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071850OtherMEDICARE - NJ
NJ9122401Medicaid
H43159Medicare UPIN