Provider Demographics
NPI:1467416172
Name:KOCH, ROBERT MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:KOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WESTCHESTER PARK DR STE 320
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3497
Mailing Address - Country:US
Mailing Address - Phone:914-948-8003
Mailing Address - Fax:914-686-5478
Practice Address - Street 1:4 WESTCHESTER PARK DR FL 4
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3434
Practice Address - Country:US
Practice Address - Phone:914-948-8448
Practice Address - Fax:914-948-0351
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221730-12086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02410391Medicaid
NY1452F1Medicare PIN
NY02410391Medicaid