Healthcare Provider Details

I. General information

NPI: 1265790224
Provider Name (Legal Business Name): COZINE DENTAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 COZINE AVE GROUND FLOOR
BROOKLYN NY
11207
US

IV. Provider business mailing address

190 COZINE AVE GROUND FLOOR
BROOKLYN NY
11207
US

V. Phone/Fax

Practice location:
  • Phone: 718-649-1398
  • Fax: 718-272-4688
Mailing address:
  • Phone: 718-649-1398
  • Fax: 718-272-4688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. VIRENDRA SHAH
Title or Position: GENERAL DENTIST
Credential: D.D.S.
Phone: 718-649-1398