Healthcare Provider Details

I. General information

NPI: 1730559113
Provider Name (Legal Business Name): JESSICA KOZLOSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W BRIDGE ST
CATSKILL NY
12414-1742
US

IV. Provider business mailing address

210 W BRIDGE ST
CATSKILL NY
12414-1742
US

V. Phone/Fax

Practice location:
  • Phone: 518-894-5425
  • Fax:
Mailing address:
  • Phone: 518-894-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: