Provider Demographics
NPI:1073377685
Name:JANSEN, KOBY MARKKO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KOBY
Middle Name:MARKKO
Last Name:JANSEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 W 119TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1356
Mailing Address - Country:US
Mailing Address - Phone:956-609-1197
Mailing Address - Fax:
Practice Address - Street 1:277 PARK AVE LBBY LEVEL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10172-0003
Practice Address - Country:US
Practice Address - Phone:212-486-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist