Healthcare Provider Details

I. General information

NPI: 1851549950
Provider Name (Legal Business Name): CHARLENE KOZAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 FRANKLIN ST STE 400
BUFFALO NY
14202-2412
US

IV. Provider business mailing address

170 FRANKLIN ST STE 400
BUFFALO NY
14202-2412
US

V. Phone/Fax

Practice location:
  • Phone: 716-856-2702
  • Fax: 716-856-8034
Mailing address:
  • Phone: 716-856-2702
  • Fax: 716-856-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number502217
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: