Basic Information
| Provider Information | |||||||||
| NPI: | 1255748158 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOZIKOWSKI | ||||||||
| FirstName: | ADAM | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 DELANCEY ST | ||||||||
| Address2: | APT. 102 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100022966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176801029 | ||||||||
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| Practice Location | |||||||||
| Address1: | 710 W 168TH ST | ||||||||
| Address2: | NEUROLOGICAL INSTITUTE, 12TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059758 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2014 | ||||||||
| LastUpdateDate: | 09/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 401733 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.