Healthcare Provider Details

I. General information

NPI: 1841283744
Provider Name (Legal Business Name): ALBERT J KOZAR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALBERT J KOZAR DO

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 W AVON RD SUITE 202
AVON CT
06001-3680
US

IV. Provider business mailing address

54 W AVON RD SUITE 202
AVON CT
06001-3680
US

V. Phone/Fax

Practice location:
  • Phone: 860-675-0357
  • Fax: 860-675-0358
Mailing address:
  • Phone: 860-675-0357
  • Fax: 860-675-0358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number040264
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number040264
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: