Healthcare Provider Details

I. General information

NPI: 1093136723
Provider Name (Legal Business Name): PATRICIA KOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2013
Last Update Date: 12/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 PRINCETON HIGHTSTOWN RD
PRINCETON JUNCTION NJ
08550-1100
US

IV. Provider business mailing address

88 PRINCETON HIGHTSTOWN RD
PRINCETON JUNCTION NJ
08550-1100
US

V. Phone/Fax

Practice location:
  • Phone: 609-497-4900
  • Fax:
Mailing address:
  • Phone: 609-497-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SC01489600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: