Provider Demographics
NPI:1871554519
Name:KOSHANSKY, KATHRYN ANN (ATC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANN
Last Name:KOSHANSKY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22 MIDDAY DR
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2315
Mailing Address - Country:US
Mailing Address - Phone:631-471-5476
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK UNIVERSITY
Practice Address - Street 2:100 NICOLLS RD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-3500
Practice Address - Country:US
Practice Address - Phone:631-632-7217
Practice Address - Fax:631-632-3231
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer