Healthcare Provider Details

I. General information

NPI: 1720799182
Provider Name (Legal Business Name): JESSICA KOZLOWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N MAPLEMERE RD STE 100
WILLIAMSVILLE NY
14221-3182
US

IV. Provider business mailing address

4225 GENESEE ST STE 400
CHEEKTOWAGA NY
14225-1994
US

V. Phone/Fax

Practice location:
  • Phone: 716-204-3200
  • Fax:
Mailing address:
  • Phone: 716-204-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number029156
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: