Healthcare Provider Details

I. General information

NPI: 1215078431
Provider Name (Legal Business Name): SOL KOZAK OPTICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 LEXINGTON AVE
NEW YORK NY
10075-0303
US

IV. Provider business mailing address

1106 LEXINGTON AVE
NEW YORK NY
10075-0303
US

V. Phone/Fax

Practice location:
  • Phone: 212-535-7272
  • Fax: 212-535-7396
Mailing address:
  • Phone: 212-535-7272
  • Fax: 212-535-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number14228
License Number StateTX

VIII. Authorized Official

Name: MR. SOL KOZAK
Title or Position: OWNER
Credential:
Phone: 212-535-7272