Individual
RUTH E KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NPP
Contact information
Practice address
31 INDUSTRIAL BOULEVARD, YAPHANK CENTER, MEDFORD, NY 11763
(631) 924-4411
(631) 924-4454
Mailing address
31 INDUSTRIAL BOULEVARD, YAPHANK CENTER, MEDFORD, NY 11763
(631) 924-4411
(631) 924-4454
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F400122
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01634124
—
NY
Enumeration date
07/10/2006
Last updated
06/04/2010
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