MEDICARE: DR. JEFFREY KOCHMAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	29077	NY

General Provider Information

NPI Number	:	1194727495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY KOCHMAN D.D.S.

Provider Business Mailing Address
First Line	:	200 W 57TH ST
Second Line	:	STE 1402
City	:	NEW YORK
State	:	NY
Zip	:	10019-3211
Country	:	US
Telephone Number	:	212-753-3560
Fax Number	:	212-753-3561

Provider Business Practice Location Address
First Line	:	200 W 57TH ST
Second Line	:	STE 1402
City	:	NEW YORK
State	:	NY
Zip	:	10019-3211
Country	:	US
Telephone Number	:	212-753-3560
Fax Number	:	212-753-3561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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