Healthcare Provider Details

I. General information

NPI: 1669224705
Provider Name (Legal Business Name): ISABELLE KOZIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST
NEWTON MA
02462-1607
US

IV. Provider business mailing address

11 MOORFIELDS CT
EAST AMHERST NY
14051-1665
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3016718
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: