Healthcare Provider Details

I. General information

NPI: 1285257998
Provider Name (Legal Business Name): JON JEFFREY KOSOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BROUGHTON RD STE B
BETHEL PARK PA
15102-2836
US

IV. Provider business mailing address

403 ROCKLEDGE DR
VENETIA PA
15367-1601
US

V. Phone/Fax

Practice location:
  • Phone: 412-851-3223
  • Fax: 412-851-3225
Mailing address:
  • Phone: 260-239-1175
  • Fax: 412-851-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number46233601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number46233601
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: