Provider Demographics
NPI:1861820342
Name:KOCH, AGATHA CHLOE (FNP, RNFA)
Entity Type:Individual
Prefix:MRS
First Name:AGATHA
Middle Name:CHLOE
Last Name:KOCH
Suffix:
Gender:F
Credentials:FNP, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 E 25TH STREET 6TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:212-813-3632
Mailing Address - Fax:212-696-0108
Practice Address - Street 1:51 E 25TH STREET 6TH FLOOR
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-813-3632
Practice Address - Fax:212-696-0108
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY626902-1163WR0006X
NY338600-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1861820342Medicaid