Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 273954 | NY |
NPI | 1003076365 |
---|---|
Provider Name | Dr. Scott Jonathan Koenig |
First Address | Garden City, NY 11530-4892 |
Second Address | Woodbury, NY 11797-2002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 27/10/2018 |