1912945296 NPI number — GARY KOZICK M.S.W.

Table of content: GARY KOZICK M.S.W. (NPI 1912945296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912945296 NPI number — GARY KOZICK M.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOZICK
Provider First Name:
GARY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.W.
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:
1912945296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2512 ANTONIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NISKAYUNA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12309-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-374-1392
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 NOTT ST
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12308-2589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-588-8346
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2006

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: 1041C0700X , with the licence number:  R039653-1 , 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: 362383 . This is a "MVP PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N226S1 . This is a "EMPIRE BC/BS MAGELLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000403575001 . This is a "BLUE SHIELD OF NORTHEAST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10072214 . This is a "CDPHP PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 476643 . This is a "VALUEOPTIONS PROVIDER NUM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7333576 . This is a "NEW YORK EMPIRE PLAN GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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