Healthcare Provider Details

I. General information

NPI: 1629020227
Provider Name (Legal Business Name): CYRIL KOZAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOLEY HTS
DELANSON NY
12053-2442
US

IV. Provider business mailing address

PO BOX 725
COOPERSTOWN NY
13326-0725
US

V. Phone/Fax

Practice location:
  • Phone: 518-895-2000
  • Fax: 518-895-2624
Mailing address:
  • Phone: 518-895-2000
  • Fax: 518-895-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number184223
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number184223
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: