Provider Demographics
NPI:1417443904
Name:JOHN, KOSHY (DPT, PTA, MS, ATC)
Entity type:Individual
Prefix:DR
First Name:KOSHY
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:DPT, PTA, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 BELLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4711
Mailing Address - Country:US
Mailing Address - Phone:917-609-4684
Mailing Address - Fax:
Practice Address - Street 1:1100 STEWART AVE STE B
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4839
Practice Address - Country:US
Practice Address - Phone:917-609-4684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-08
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
NY014613225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer