1295712891 NPI number — DR. ERIC MYLES KOSOFSKY DPM

Table of content: DR. ERIC MYLES KOSOFSKY DPM (NPI 1295712891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295712891 NPI number — DR. ERIC MYLES KOSOFSKY DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOSOFSKY
Provider First Name:
ERIC
Provider Middle Name:
MYLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1295712891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
999 ASYLUM AVE STE 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06105-2416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-523-8026
Provider Business Mailing Address Fax Number:
860-523-7622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 ASYLUM AVE STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06105-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-523-8026
Provider Business Practice Location Address Fax Number:
860-523-7622
Provider Enumeration Date:
12/27/2005

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: 213ES0131X , with the licence number:  000468 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 000468 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0190960002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 030000468CT04 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0744660001 . This is a "HEALTH NOW OF NEW YORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0533188 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060468 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: HAS384 . This is a "ORTHONET/OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061280198003 . This is a "ALLIED HEALTH GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004162476 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 061280198 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0P0501 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480007333 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: C14746 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".