Healthcare Provider Details

I. General information

NPI: 1285152561
Provider Name (Legal Business Name): MRS. JAMIE J KOCHMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SMITH LN
CENTEREACH NY
11720-3878
US

IV. Provider business mailing address

107 SMITH LN
CENTEREACH NY
11720-3878
US

V. Phone/Fax

Practice location:
  • Phone: 631-935-2523
  • Fax:
Mailing address:
  • Phone: 631-935-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: