1902874423 NPI number — LISA KOZDEN MOT, OTR/L, CHT

Table of content: DR. OZAN DIKILITAS MD (NPI 1871176883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902874423 NPI number — LISA KOZDEN MOT, OTR/L, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOZDEN
Provider First Name:
LISA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MOT, OTR/L, CHT
Provider Gender Code:
F

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:
1902874423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1078 WYOMING AVE
Provider Second Line Business Mailing Address:
# 175
Provider Business Mailing Address City Name:
WYOMING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18644-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-509-1328
Provider Business Mailing Address Fax Number:
888-875-5883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 N RIVER ST
Provider Second Line Business Practice Location Address:
UNIT 5
Provider Business Practice Location Address City Name:
PLAINS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18705-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-820-5900
Provider Business Practice Location Address Fax Number:
888-875-5883
Provider Enumeration Date:
03/10/2006

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: 225XH1200X , with the licence number:  OC007257L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com