1902804347 NPI number — DR. JASON EVERETT KOOCH D.O.

Table of content: MRS. SAMANTHA J PERSINGER M.ED, CRC (NPI 1225528425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902804347 NPI number — DR. JASON EVERETT KOOCH D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOOCH
Provider First Name:
JASON
Provider Middle Name:
EVERETT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902804347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 EILEEN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYOSSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11791-5323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-795-3033
Provider Business Mailing Address Fax Number:
516-795-3036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 EILEEN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYOSSET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11791-5323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-795-3033
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  OS013001 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: 326507 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50044478 . This is a "KEYSTONE HEALTH CENTRAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6432850 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2170526 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2299715000 . This is a "INDEPENDENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50044478 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2299715000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 397414 . This is a "HEALTH AMERICA/HEALTH ASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 821131 . This is a "FIRST PRIORITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1622793 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2299715000 . This is a "KEYSTONE HEALTH EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7466584 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90338 . This is a "GEISINGER HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3356842 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1011608520001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2458473 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00230776 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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