Provider Demographics
NPI:1174635270
Name:KOCHEM, DENNIS T SR
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:T
Last Name:KOCHEM
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 JOHNNYCAKE HILL RD.
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346
Mailing Address - Country:US
Mailing Address - Phone:315-824-4515
Mailing Address - Fax:315-824-4515
Practice Address - Street 1:2409 JOHNNYCAKE HILL RD.
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346
Practice Address - Country:US
Practice Address - Phone:315-824-4515
Practice Address - Fax:315-824-4515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1176750001Medicare ID - Type Unspecified