Basic Information
| Provider Information | |||||||||
| NPI: | 1497036941 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOSHYK | ||||||||
| FirstName: | MARYANA | ||||||||
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| Credential: | RPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 ROBERTS AVE | ||||||||
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| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107031511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149608402 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 WOODS RD | ||||||||
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| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105951530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144937000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2011 | ||||||||
| LastUpdateDate: | 08/29/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 0149831 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.