1366418444 NPI number — DR. WESLEY P KOZINN MD

Table of content: (NPI 1235145038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366418444 NPI number — DR. WESLEY P KOZINN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOZINN
Provider First Name:
WESLEY
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1366418444
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2061 FAIRVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18042-3953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-253-7818
Provider Business Mailing Address Fax Number:
610-253-1764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2061 FAIRVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18042-3953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-253-7818
Provider Business Practice Location Address Fax Number:
610-253-1764
Provider Enumeration Date:
02/27/2006

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: 207RI0200X , with the licence number:  MD020649E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0200X , with the licence number: MA043384 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 20008785 , issued by the state of ( PW ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2626165 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA3654 . This is a "MULTI PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 03050500 . This is a "KEYSTONE SENIOR BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232167970 . This is a "QUALCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 469374 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000605770 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0041200000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232167970 . This is a "HORIZON BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 232167970 . This is a "BEECH STREET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 03050500 . This is a "CAPITOL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 025420 . This is a "AMERI HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 025420 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0991406 . This is a "KEYSTONE HEALTH PLAN CENT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232167970 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232167970 . This is a "INTERGROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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