Healthcare Provider Details

I. General information

NPI: 1689817272
Provider Name (Legal Business Name): GORGI KOZESKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2009
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 11TH AVE
ALTOONA PA
16601-3301
US

IV. Provider business mailing address

1321 11TH AVE
ALTOONA PA
16601-3301
US

V. Phone/Fax

Practice location:
  • Phone: 814-942-2411
  • Fax: 814-943-6291
Mailing address:
  • Phone: 814-942-2411
  • Fax: 814-943-6291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberDO034355
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberOS016200
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: