Provider Demographics
NPI:1629107560
Name:KOCH, JOSHUA D (MS, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:D
Last Name:KOCH
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JETS DR
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1215
Mailing Address - Country:US
Mailing Address - Phone:973-549-4703
Mailing Address - Fax:973-549-4708
Practice Address - Street 1:1 JETS DR
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1215
Practice Address - Country:US
Practice Address - Phone:973-549-4703
Practice Address - Fax:973-549-4708
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001458-12255A2300X
NJ25MT001326002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer