Basic Information
| Provider Information | |||||||||
| NPI: | 1568541795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOZLOWSKI | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 755 NEW YORK AVE | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313517676 | ||||||||
| FaxNumber: | 6313517667 | ||||||||
| Practice Location | |||||||||
| Address1: | 755 NEW YORK AVE | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313517676 | ||||||||
| FaxNumber: | 6313517667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 03/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 015321-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | QL3351 | 01 | BCBS | OTHER | QL3352 | 01 | BCB | OTHER |