Provider Demographics
NPI:1851328330
Name:KOKOLIS, KOSTA (MS, PT)
Entity Type:Individual
Prefix:
First Name:KOSTA
Middle Name:
Last Name:KOKOLIS
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4106 BELL BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2857
Mailing Address - Country:US
Mailing Address - Phone:718-279-9800
Mailing Address - Fax:718-279-9500
Practice Address - Street 1:110 E 23RD ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4517
Practice Address - Country:US
Practice Address - Phone:212-529-5700
Practice Address - Fax:212-529-3415
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY023936-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ06L21Medicare ID - Type Unspecified
NY06566GMedicare ID - Type Unspecified