Provider Demographics
NPI:1386958080
Name:KOKE, CHRISTOPHER TRAVIS (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TRAVIS
Last Name:KOKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SPRINGVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2290
Mailing Address - Country:US
Mailing Address - Phone:631-283-1126
Mailing Address - Fax:
Practice Address - Street 1:518 MONTAUK HWY STE 102
Practice Address - Street 2:
Practice Address - City:AMAGANSETT
Practice Address - State:NY
Practice Address - Zip Code:11930-2110
Practice Address - Country:US
Practice Address - Phone:631-267-5373
Practice Address - Fax:631-267-5376
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261724204D00000X, 207Q00000X
SCDO37832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM