Merlyn Jacob Koshy, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

018251 Issued in NY

Practice address

600 Roe Avenue
Elmira, NY 14905-1629

Phone

(607) 737-4508

Fax

(607) 735-5738

NPI assigned

Dec 13, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Mrs. Merlyn Jacob Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606262400000",
    "number": "1780082313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "571 SAINT JOSEPHS BLVD FL 2",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013230",
            "telephone_number": "607-271-2050",
            "fax_number": "607-873-1244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 ROE AVENUE",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149051629",
            "telephone_number": "607-737-4508",
            "fax_number": "607-735-5738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSHY",
        "first_name": "MERLYN",
        "middle_name": "JACOB",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-13",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00351600",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103367085",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04342201",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MERLYN",
            "last_name": "JACOB",
            "prefix": "MRS.",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christine Renee Koernig, PA-C
• Sallyanne Kohut, M.S. CCC-SLP
• Agnieszka Daria Kolano
• James Frank Kolynich, PA
• Joshua William Kopp
• Michele Kotch
• Jason Charles Kotmel, PT
• Jessica Kozdemba
• Nathaniel Kozyra, PT, DPT
• Madelyn Rose Kramer

• Physician Assistant in Elmira, NY
• Providers in Elmira, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.