Healthcare Provider Details

I. General information

NPI: 1396798872
Provider Name (Legal Business Name): LEONID KOZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 E 12TH ST FL 2NF
BROOKLYN NY
11229-1088
US

IV. Provider business mailing address

1550 E 13TH ST APT 6-G
BROOKLYN NY
11230-7158
US

V. Phone/Fax

Practice location:
  • Phone: 718-375-2825
  • Fax: 718-375-4231
Mailing address:
  • Phone: 718-375-2825
  • Fax: 718-375-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number210014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: