Healthcare Provider Details

I. General information

NPI: 1396256103
Provider Name (Legal Business Name): YOUNG DUK KOSKEY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YOUNG DUK KOSKEY YOUNG KOSKEY FNP-BC

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BROAD ST RM 815
NEW YORK NY
10004-3233
US

IV. Provider business mailing address

75 BROAD ST RM 815
NEW YORK NY
10004-3233
US

V. Phone/Fax

Practice location:
  • Phone: 347-761-3168
  • Fax: 929-285-9069
Mailing address:
  • Phone: 347-761-3168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: