Provider Demographics
NPI:1467713206
Name:KOCH, YONATAN YAAKOV
Entity Type:Individual
Prefix:MR
First Name:YONATAN
Middle Name:YAAKOV
Last Name:KOCH
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 1:116 VAN GUILDER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5406
Mailing Address - Country:US
Mailing Address - Phone:516-458-2324
Mailing Address - Fax:
Practice Address - Street 1:116 VAN GUILDER AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5406
Practice Address - Country:US
Practice Address - Phone:516-458-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist