Healthcare Provider Details

I. General information

NPI: 1750678066
Provider Name (Legal Business Name): ANDREA KOZODOY MSQ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NORTH AVE E
CRANFORD NJ
07016-2435
US

IV. Provider business mailing address

300 NORTH AVE E
CRANFORD NJ
07016-2435
US

V. Phone/Fax

Practice location:
  • Phone: 908-276-2244
  • Fax: 908-931-0304
Mailing address:
  • Phone: 908-276-2244
  • Fax: 908-931-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SC04623800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: