=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477859098
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OSKIE PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2011
-----------------------------------------------------
Last Update Date | 12/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 555 KNOWLES DR STE 219
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-1551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-378-6171
-----------------------------------------------------
Fax | 408-378-0721
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 555 KNOWLES DR STE 219
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-1551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-378-6171
-----------------------------------------------------
Fax | 408-378-0721
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LEWIS A. OSOFSKY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 408-378-6171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A77790
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | G47908
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------