Provider Demographics
NPI:1831401777
Name:KOCH, LESZEK (PTA)
Entity type:Individual
Prefix:MR
First Name:LESZEK
Middle Name:
Last Name:KOCH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 MADISON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5201
Mailing Address - Country:US
Mailing Address - Phone:212-685-8113
Mailing Address - Fax:212-697-4541
Practice Address - Street 1:317 MADISON AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5201
Practice Address - Country:US
Practice Address - Phone:212-685-8113
Practice Address - Fax:212-697-4541
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001478-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant