Healthcare Provider Details

I. General information

NPI: 1245314814
Provider Name (Legal Business Name): ALEXANDRA KOZUSKO APRN - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PENN PLZ 8TH FLOOR
NEW YORK NY
10119-0002
US

IV. Provider business mailing address

1 PENN PLZ 8TH FLOOR
NEW YORK NY
10119-0002
US

V. Phone/Fax

Practice location:
  • Phone: 212-216-6436
  • Fax:
Mailing address:
  • Phone: 212-216-6436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number331594
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: