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NPI Code Detail

MEDICARE: MR. MATTHEW KOSMADAKIS

MEDICARE:  MR. MATTHEW  KOSMADAKIS
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
1183500000XPharmacist28RI02641600NJ

General Provider Information

NPI Number : 1760766562
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW KOSMADAKIS
Provider Business Mailing Address
First Line : 2151 LEMOINE AVE
Second Line :
City : FORT LEE
State : NJ
Zip : 07024-6041
Country : US
Telephone Number : 201-947-6772
Fax Number :
Provider Business Practice Location Address
First Line : 2151 LEMOINE AVE
Second Line :
City : FORT LEE
State : NJ
Zip : 07024-6041
Country : US
Telephone Number : 201-947-6772
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2011
Last Update Date : 09/29/2011

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Directions to “ MR. MATTHEW KOSMADAKIS ” Practice Location

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