Provider Demographics
NPI:1134221922
Name:KOSHEFF, MITCHELL I (PT DPT PHYSICAL THER)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:I
Last Name:KOSHEFF
Suffix:
Gender:M
Credentials:PT DPT PHYSICAL THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 DAHLIA CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4132
Mailing Address - Country:US
Mailing Address - Phone:732-642-5055
Mailing Address - Fax:732-370-4475
Practice Address - Street 1:1500 DAHLIA COURT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527
Practice Address - Country:US
Practice Address - Phone:732-370-4475
Practice Address - Fax:732-370-4475
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0178251225100000X
NJ40QA00649900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
002738Medicare ID - Type Unspecified