Provider Demographics
NPI:1609004787
Name:KOSHIBE, GEN (MD)
Entity type:Individual
Prefix:DR
First Name:GEN
Middle Name:
Last Name:KOSHIBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:730 PALISADE AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666
Mailing Address - Country:US
Mailing Address - Phone:201-928-2160
Mailing Address - Fax:201-287-8385
Practice Address - Street 1:730 PALISADE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:201-928-2160
Practice Address - Fax:201-287-8385
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08530100207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology