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General NPI Number Information
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NPI Number | 1285257998
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Entity Type | Individual
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Provider Name | JON JEFFREY KOSOR
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Gender | Male
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 100 BROUGHTON RD STE B
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City | BETHEL PARK
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State | PA
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Zip | 15102-2836
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Country | US
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Telephone | 412-851-3223
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Fax | 412-851-3225
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Provider Business Mailing Address
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Address Line | 403 ROCKLEDGE DR
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City | VENETIA
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State | PA
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Zip | 15367-1601
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Country | US
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Telephone | 260-239-1175
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Fax | 412-851-3225
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 46233601
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 46233601
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License Number State | PA
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