Healthcare Provider Details

I. General information

NPI: 1730079815
Provider Name (Legal Business Name): MADISON KOZLOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 MAIN ST
BUFFALO NY
14214-3001
US

IV. Provider business mailing address

139 SAGEWOOD TER
WILLIAMSVILLE NY
14221-4717
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-2537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number850201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: