Healthcare Provider Details

I. General information

NPI: 1053481259
Provider Name (Legal Business Name): PAUL KOENIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMC - DEPT. OF PEDIATRICS 3444 KOSSUTH AVENUE
BRONX NY
10467
US

IV. Provider business mailing address

126 SURREY LN
TENAFLY NJ
07670-2517
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-5872
  • Fax:
Mailing address:
  • Phone: 718-920-5872
  • Fax: 718-652-5707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number141980
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: