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General NPI Number Information
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NPI Number | 1417443904
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Entity Type | Individual
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Provider Name | KOSHY JOHN DPT, PTA, MS, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/08/2018
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 1100 STEWART AVE STE B
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City | GARDEN CITY
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State | NY
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Zip | 11530-4839
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Country | US
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Telephone | 917-609-4684
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Fax |
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Provider Business Mailing Address
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Address Line | 584 BELLMORE AVE
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City | EAST MEADOW
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State | NY
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Zip | 11554-4711
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Country | US
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Telephone | 917-609-4684
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 014613
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License Number State | NY
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