MEDICARE: DR. PAUL M KOSLOW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N005473	NY
2	213ES0131X	Foot Surgery Podiatrist	N005473	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1499548	OTHER	NY	GHI

General Provider Information

NPI Number	:	1629018627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL M KOSLOW

Provider Business Mailing Address
First Line	:	8911 63RD DR
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-3852
Country	:	US
Telephone Number	:	718-639-9887
Fax Number	:	718-457-5308

Provider Business Practice Location Address
First Line	:	8911 63RD DR
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-3852
Country	:	US
Telephone Number	:	718-639-9887
Fax Number	:	718-457-5308

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	08/23/2010

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Directions to “ DR. PAUL M KOSLOW ” Practice Location

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