=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821090200
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GRZEGORZ KOZIKOWSKI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2005
-----------------------------------------------------
Last Update Date | 04/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 146 NORMAN AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11222-3385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-349-1221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14222 13TH AVE
-----------------------------------------------------
City | WHITESTONE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11357-2319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-208-3244
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 222249
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------