MEDICARE: JOSEPH ROBERT KOKA M.D.

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	207VG0400X	Gynecology Physician	166167	NY
2	207VX0000X	Obstetrics Physician	166167	NY
3	207V00000X	Obstetrics & Gynecology Physician	166167	NY

General Provider Information

NPI Number	:	1972689503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH ROBERT KOKA M.D.

Provider Business Mailing Address
First Line	:	22 WATERVILLE RD
Second Line	:
City	:	AVON
State	:	CT
Zip	:	06001-2066
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 MINEOLA BLVD STE 100
Second Line	:
City	:	MINEOLA
State	:	NY
Zip	:	11501-4077
Country	:	US
Telephone Number	:	516-663-3010
Fax Number	:

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	03/24/2021

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