Provider Demographics
NPI:1255840716
Name:KOCHMAN, KIMBERLY IZZO (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:IZZO
Last Name:KOCHMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PINE DR
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-1017
Mailing Address - Country:US
Mailing Address - Phone:631-786-8871
Mailing Address - Fax:
Practice Address - Street 1:1267 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2676
Practice Address - Country:US
Practice Address - Phone:631-651-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant