Healthcare Provider Details

I. General information

NPI: 1700650744
Provider Name (Legal Business Name): MS. KAREN LEE KOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 JOHN MUIR DR
AMHERST NY
14228-1144
US

IV. Provider business mailing address

95 JOHN MUIR DR
AMHERST NY
14228-1144
US

V. Phone/Fax

Practice location:
  • Phone: 800-543-9399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number536064-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: