Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 219191 | NY |
NPI | 1043589203 |
---|---|
Provider Name | Dr. John Koski |
First Address | New York, NY 10021-1400 |
Second Address | New York, NY 10021-1400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2011 |
Last Update Date | 17/12/2011 |