Provider Demographics
NPI:1699785170
Name:KOESTLER, JENNIFER LYN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYN
Last Name:KOESTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:62 WHIPPOORWILL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-2314
Mailing Address - Country:US
Mailing Address - Phone:914-594-4609
Mailing Address - Fax:914-594-4838
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-593-8850
Practice Address - Fax:914-593-8833
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207294207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02131322Medicaid
NYH31798Medicare UPIN