MEDICARE: DUSHAN KOSOVICH MD PC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1851620397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUSHAN KOSOVICH MD PC

Provider Business Mailing Address
First Line	:	333 E 46TH ST
Second Line	:	1G
City	:	NEW YORK
State	:	NY
Zip	:	10017-7401
Country	:	US
Telephone Number	:	212-661-9449
Fax Number	:	212-661-1882

Provider Business Practice Location Address
First Line	:	333 E 46TH ST
Second Line	:	1G
City	:	NEW YORK
State	:	NY
Zip	:	10017-7401
Country	:	US
Telephone Number	:	212-661-9449
Fax Number	:	212-661-1882

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DUSHAN KOSOVICH
Credential	:
Telephone Number	:	212-661-9449

Provider Enumeration Date	:	12/11/2009
Last Update Date	:	12/11/2009

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