Northern Valley Id, PC

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

Legal business name

NORTHERN VALLEY ID, PC

Practice address

400 Sylvan Ave Ste 108
Englewood Cliffs, NJ 07632-2717

Phone

(201) 408-5314

NPI assigned

Nov 6, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Pan KoNPI 1083851687

Title

President

Phone

(201) 408-5314

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pan Sok Ko, M.D.

  • Infectious Disease Physician
  • Englewood Cliffs, NJ
  • NPI 1083851687
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541462400000",
    "number": "1013485226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 SYLVAN AVE STE 108",
            "city": "ENGLEWOOD CLIFFS",
            "state": "NJ",
            "postal_code": "076322717",
            "telephone_number": "201-408-5314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 SYLVAN AVE STE 108",
            "city": "ENGLEWOOD CLIFFS",
            "state": "NJ",
            "postal_code": "076322717",
            "telephone_number": "201-408-5314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN VALLEY ID, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-06",
        "last_updated": "2018-11-06",
        "status": "A",
        "authorized_official_last_name": "KO",
        "authorized_official_first_name": "PAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-408-5314"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Infectious Disease Physician in Englewood Cliffs, NJ
• Providers in Englewood Cliffs, NJ by specialty
• Infectious Disease Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.