Healthcare Provider Details

I. General information

NPI: 1144352949
Provider Name (Legal Business Name): HARLAN KOSSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 NYE RD
LYONS NY
14489-9133
US

IV. Provider business mailing address

PO BOX 309
PITTSFORD NY
14534-0309
US

V. Phone/Fax

Practice location:
  • Phone: 845-294-0568
  • Fax:
Mailing address:
  • Phone: 845-294-0568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number148286
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number148286
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number148286
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number148286
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: