Provider Demographics
NPI:1063502870
Name:KOO, JIMMY L (MD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:L
Last Name:KOO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:CARE MOUNT MEDICAL PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:48 ROUTE 6 STE 102
Practice Address - Street 2:CARE MOUNT MEDCICAL PC
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598
Practice Address - Country:US
Practice Address - Phone:914-248-5556
Practice Address - Fax:914-248-4091
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2018-06-06
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Provider Licenses
StateLicense IDTaxonomies
NY1516631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00921673Medicaid
C10721Medicare UPIN
NY51D0606761Medicare PIN
NY00921673Medicaid
110199213Medicare PIN