Healthcare Provider Details

I. General information

NPI: 1669335071
Provider Name (Legal Business Name): JESSICA KOZINETS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 108TH ST APT 6G
FOREST HILLS NY
11375-1322
US

IV. Provider business mailing address

6309 108TH ST APT 6G
FOREST HILLS NY
11375-1322
US

V. Phone/Fax

Practice location:
  • Phone: 347-585-8075
  • Fax:
Mailing address:
  • Phone: 347-585-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: