Basic Information
Provider Information
NPI: 1215386859
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KOCI
FirstName: KRISTAQ
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 150 E 42ND ST FL 9
Address2:  
City: NEW YORK
State: NY
PostalCode: 100175699
CountryCode: US
TelephoneNumber: 6466058186
FaxNumber:  
Practice Location
Address1: 425 W 59TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100198022
CountryCode: US
TelephoneNumber: 2125235900
FaxNumber: 2125808582
Other Information
ProviderEnumerationDate: 06/04/2016
LastUpdateDate: 06/29/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/28/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207RR0500X310302NYY Allopathic & Osteopathic PhysiciansInternal MedicineRheumatology

No ID Information.


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