Basic Information
| Provider Information | |||||||||
| NPI: | 1316960818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOSACK | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | DINGMAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 HALF MILE RD | ||||||||
| Address2: | |||||||||
| City: | NORTH HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064733507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038095908 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 YORK STREET | ||||||||
| Address2: | YNHH NBSCU | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036882320 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 02/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 000821 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.