Healthcare Provider Details

I. General information

NPI: 1376609115
Provider Name (Legal Business Name): DALE ROBIN KOZINN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SQUADRON BLVD
NEW CITY NY
10956-5210
US

IV. Provider business mailing address

18 SQUADRON BLVD
NEW CITY NY
10956
US

V. Phone/Fax

Practice location:
  • Phone: 845-770-6059
  • Fax: 845-708-0488
Mailing address:
  • Phone: 845-770-6059
  • Fax: 845-708-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA05515300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number247409
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: