Healthcare Provider Details

I. General information

NPI: 1407609423
Provider Name (Legal Business Name): JANINE KOEHLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 WHEELER RD
CENTRAL ISLIP NY
11722-2154
US

IV. Provider business mailing address

234 WENSLEY LN
EAST ISLIP NY
11730-3516
US

V. Phone/Fax

Practice location:
  • Phone: 631-348-5000
  • Fax: 631-348-4433
Mailing address:
  • Phone: 631-872-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number526869-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: