Healthcare Provider Details

I. General information

NPI: 1427194562
Provider Name (Legal Business Name): ANNA KOZLOWSKA MS,L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 SOUNDVIEW AVE
SOUTHOLD NY
11971-2736
US

IV. Provider business mailing address

7345 SOUNDVIEW AVE
SOUTHOLD NY
11971-2736
US

V. Phone/Fax

Practice location:
  • Phone: 631-765-5174
  • Fax: 631-765-5174
Mailing address:
  • Phone: 631-765-5174
  • Fax: 631-765-5174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002761
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: