MEDICARE: ROXANNE LEILANI KO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	333663	NY

General Provider Information

NPI Number	:	1821678061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANNE LEILANI KO MD

Provider Business Mailing Address
First Line	:	8211 37TH AVE FL 5
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7010
Country	:	US
Telephone Number	:	718-567-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	82-11 37TH AVE
Second Line	:	FLOOR 5
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1137
Country	:	US
Telephone Number	:	718-567-5200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2021
Last Update Date	:	01/22/2025

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