Provider Demographics
NPI:1679790422
Name:KOHAN, SHARONA (OD)
Entity type:Individual
Prefix:DR
First Name:SHARONA
Middle Name:
Last Name:KOHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7320
Mailing Address - Country:US
Mailing Address - Phone:718-426-2725
Mailing Address - Fax:718-426-9748
Practice Address - Street 1:8325 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7320
Practice Address - Country:US
Practice Address - Phone:718-426-2725
Practice Address - Fax:718-426-9748
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02707082Medicaid
NYG400002433Medicare UPIN