1427102425 NPI number — KEVIN LOUIS KOZARA D.O.

Table of content: KEVIN LOUIS KOZARA D.O. (NPI 1427102425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427102425 NPI number — KEVIN LOUIS KOZARA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOZARA
Provider First Name:
KEVIN
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1427102425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 KINGS HWY S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14617-5504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-244-3510
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 LINDEN OAKS
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14625-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-442-4200
Provider Business Practice Location Address Fax Number:
585-244-3519
Provider Enumeration Date:
01/23/2007

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: 207Y00000X , with the licence number:  242533 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02867554 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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