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General NPI Number Information
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NPI Number | 1598847915
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Entity Type | Individual
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Provider Name | JOSEPH MICHAEL KOCH A.T.C.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 1 BRYANT DR
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City | SUCCASUNNA
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State | NJ
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Zip | 07876-1632
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Country | US
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Telephone | 973-584-1200
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Fax | 973-584-4107
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Provider Business Mailing Address
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Address Line | 89 SUMMIT AVE
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City | CEDAR KNOLLS
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State | NJ
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Zip | 07927-1410
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Country | US
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Telephone | 973-998-9398
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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 | 25MT00059400
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License Number State | NJ
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