=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982856985
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KOSICA HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2008
-----------------------------------------------------
Last Update Date | 10/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8966 211TH ST
-----------------------------------------------------
City | QUEENS VILLAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11427-2308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-715-4246
-----------------------------------------------------
Fax | 718-715-4246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8966 211TH ST
-----------------------------------------------------
City | QUEENS VILLAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11427-2308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-715-4246
-----------------------------------------------------
Fax | 718-715-4246
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. ANNE O. ANIEKWE
-----------------------------------------------------
Credential | RN,BSN,BSECON.
-----------------------------------------------------
Telephone | 718-715-4246
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------