Individual
NICOLETA V KOSCHACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
500 COMMACK RD, COMMACK, NY 11725-5020
(631) 638-0736
(631) 630-6297
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 444-8478
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F307021
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AG1114075
AANP
NY
Enumeration date
08/28/2015
Last updated
11/04/2020
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