Healthcare Provider Details

I. General information

NPI: 1194727495
Provider Name (Legal Business Name): JEFFREY KOCHMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 57TH ST STE 1402
NEW YORK NY
10019-3211
US

IV. Provider business mailing address

200 W 57TH ST STE 1402
NEW YORK NY
10019-3211
US

V. Phone/Fax

Practice location:
  • Phone: 212-753-3560
  • Fax: 212-753-3561
Mailing address:
  • Phone: 212-753-3560
  • Fax: 212-753-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number29077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: