Individual
BRAD KOEGEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
30-46 35TH STREET, ASTORIA, NY 11103
(516) 425-3112
Mailing address
3046 35TH ST, ASTORIA, NY 11103-4702
(516) 425-3112
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
NY
225100000X
Physical Therapist
Primary
043263-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113488835
STRIVRIGHT
NY
Enumeration date
02/25/2015
Last updated
11/12/2020
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