Healthcare Provider Details

I. General information

NPI: 1053397125
Provider Name (Legal Business Name): DAVID R. KOSOFSKY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 KINSLEY ST STE 201
NASHUA NH
03060-3676
US

IV. Provider business mailing address

166 KINSLEY ST STE 201
NASHUA NH
03060-3676
US

V. Phone/Fax

Practice location:
  • Phone: 603-880-9177
  • Fax: 603-880-9672
Mailing address:
  • Phone: 603-880-9177
  • Fax: 603-880-9672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number166
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: