Provider Demographics
NPI:1871739748
Name:KOTB, MOHY ELDIN A (MD)
Entity type:Individual
Prefix:DR
First Name:MOHY ELDIN
Middle Name:A
Last Name:KOTB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:36-42 NEWARK ST STE 302
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5655
Mailing Address - Country:US
Mailing Address - Phone:201-533-0222
Mailing Address - Fax:201-533-0223
Practice Address - Street 1:36-42 NEWARK ST STE 302
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5655
Practice Address - Country:US
Practice Address - Phone:201-533-0222
Practice Address - Fax:201-533-0223
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA095566002080P0202X
NY2626552080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0434370Medicaid