Healthcare Provider Details

I. General information

NPI: 1538505953
Provider Name (Legal Business Name): PAULINA KOZLOWSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAULINA COOTS M.D.

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number244202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: