| Doctor Name: | JESSICA MARIE KOENIG |
| NPI Number: | 1134532799 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 163424 |
| Business Practice Address: | 52 Harding St East Northport, NY - 117311111 |
| Business Phone Number: | 9176037871 |
| Business Fax Number: | |
| Mailing Address: | 52 Harding St, EAST NORTHPORT |
| State: | NY |
| Postal Code: | 117311111 |
| Phone Number: | 9176037871 |
| Fax Number: | |
| NPI Enumeration Date: | 06/10/2014 |
| NPI Last Update Date: | 06/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246XS1301X |
| License Number: | 163424 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Spec/Tech, Cardiovascular |
| Taxonomy Specialization: | Sonography |
| Taxonomy Definition: | |