Provider Demographics
NPI:1346316171
Name:KOSTERICH, STEVEN E
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:E
Last Name:KOSTERICH
Suffix:
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 1:5 NORTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10505
Mailing Address - Country:US
Mailing Address - Phone:914-636-4113
Mailing Address - Fax:914-636-7839
Practice Address - Street 1:5 NORTH AVENUE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10505
Practice Address - Country:US
Practice Address - Phone:914-636-4113
Practice Address - Fax:914-636-7839
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0060761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
133703295OtherTIN
NYX37561Medicare ID - Type Unspecified