Healthcare Provider Details

I. General information

NPI: 1558352369
Provider Name (Legal Business Name): JEFFREY P KOZLOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 GODWIN AVE SUITE 301
MIDLAND PARK NJ
07432-1969
US

IV. Provider business mailing address

44 GODWIN AVE SUITE 301
MIDLAND PARK NJ
07432-1969
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-0013
  • Fax: 201-447-0438
Mailing address:
  • Phone: 201-447-0013
  • Fax: 201-447-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25MA04372700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: