MEDICARE: MISS EILEEN KATHERINE KOSIERACKI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	184108-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5900220	OTHER	NY	GHI
2	010184108	OTHER	NY	BC/BS ROCHESTER BLUE CHOI
3	0103805	OTHER	NY	INDEPENDENT HEALTH
4	00010093901	OTHER	NY	UNIVERA
5	5745356	OTHER	NY	AETNA
6	MD134P	OTHER	NY	PREFERRED CARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	000511199002	OTHER	NY	COMMUNITY BLUE/ BC/BS BUF

General Provider Information

NPI Number	:	1174520589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EILEEN KATHERINE KOSIERACKI D.O.

Provider Business Mailing Address
First Line	:	3916 LONG BRIDGE RD
Second Line	:
City	:	ALBION
State	:	NY
Zip	:	14411-9310
Country	:	US
Telephone Number	:	585-589-6247
Fax Number	:	585-589-6351

Provider Business Practice Location Address
First Line	:	3916 LONG BRIDGE RD
Second Line	:
City	:	ALBION
State	:	NY
Zip	:	14411-9310
Country	:	US
Telephone Number	:	585-589-6247
Fax Number	:	585-589-6351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	12/09/2011

Similar Medicare Providers

1700156072 — EILEEN K. KOSIERACKI, D.O.,P.C.
Practice Location Address:

3916 LONG BRIDGE RD
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14411-9310

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1104758275 — IYANNA DESIREE DAVIS
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1376549808 — DR. BRENDA L BIERDEMAN PSY.D.
Practice Location Address:

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Practice Location Address:

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1245206127 — CENTRAL ORLEANS VOLUNTEER AMBULANCE, INC.
Practice Location Address:

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Directions to “ MISS EILEEN KATHERINE KOSIERACKI D.O.” Practice Location

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