Healthcare Provider Details

I. General information

NPI: 1578858593
Provider Name (Legal Business Name): KATARZYNA KOCON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6927 164TH ST
FRESH MEADOWS NY
11365-3195
US

IV. Provider business mailing address

15 WOODLAND RD
VALLEY STREAM NY
11581-1725
US

V. Phone/Fax

Practice location:
  • Phone: 212-444-8933
  • Fax:
Mailing address:
  • Phone: 516-849-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346737
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: