Individual
STEPHANIE MCKINNEY KOO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
535 E 70TH ST, NEW YORK, NY 10021-4823
(212) 606-1000
Mailing address
423 E 83RD ST APT 3B, NEW YORK, NY 10028-5520
(248) 396-2718
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002148
CT
363AS0400X
Surgical Physician Assistant
Primary
013524
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002148
CONNECTICUT LICENSE
CT
01
—
013524
NEW YORK LICENSE
NY
Enumeration date
09/11/2008
Last updated
04/15/2021
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