Healthcare Provider Details

I. General information

NPI: 1467912618
Provider Name (Legal Business Name): PAUL KOZLOWSKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NICOLLS RD HEALTH SCIENCES CENTER L4-060 (Z8480)
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

19102 35TH AVE
AUBURNDALE NY
11358-1920
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2078
  • Fax:
Mailing address:
  • Phone: 347-837-2181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number325410
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: