Healthcare Provider Details

I. General information

NPI: 1275728560
Provider Name (Legal Business Name): DEEPU KOSHY ALEXANDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E MAIN ST SUITE 120
PATCHOGUE NY
11772-3114
US

IV. Provider business mailing address

325 E MAIN ST SUITE 120
PATCHOGUE NY
11772-3114
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-3278
  • Fax: 631-654-1474
Mailing address:
  • Phone: 631-654-3278
  • Fax: 631-654-1474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number245999
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number245999
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: