Basic Information
| Provider Information | |||||||||
| NPI: | 1427033547 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OZA | ||||||||
| FirstName: | KULIN | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 FOX ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126014723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454312400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 101 HEALTH CARE DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622461159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186642531 | ||||||||
| FaxNumber: | 6186642553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2005 | ||||||||
| LastUpdateDate: | 04/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 036144417 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD-44644 | IA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 25MA06359300 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 309520 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7000502 | 05 | NJ | MEDICAID |