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NPI Code Detail

MEDICARE: JEFFREY A KOEHLER PA

MEDICARE: JEFFREY A KOEHLER PA
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
1363AS0400XSurgical Physician Assistant004183-1NY

General Provider Information

NPI Number : 1598837643
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY A KOEHLER PA
Provider Business Mailing Address
First Line : 736 IRVING AVE
Second Line : 5 WEST TOWER ROOM 5632
City : SYRACUSE
State : NY
Zip : 13210-1687
Country : US
Telephone Number : 315-470-7111
Fax Number :
Provider Business Practice Location Address
First Line : 736 IRVING AVE
Second Line : 5 WEST TOWER ROOM 5632
City : SYRACUSE
State : NY
Zip : 13210-1687
Country : US
Telephone Number : 315-470-7111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2006
Last Update Date : 01/12/2010

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Directions to “ JEFFREY A KOEHLER PA” Practice Location

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