Provider Demographics
NPI:1902993561
Name:KOSS, MARIANNA (PA)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNA
Middle Name:
Last Name:KOSS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E 61ST ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-8722
Mailing Address - Country:US
Mailing Address - Phone:718-265-0005
Mailing Address - Fax:718-265-2410
Practice Address - Street 1:425 E 61ST ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8722
Practice Address - Country:US
Practice Address - Phone:212-752-2900
Practice Address - Fax:212-752-2949
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006256-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02353208Medicaid
NY5F25638321Medicare PIN