Basic Information
| Provider Information | |||||||||
| NPI: | 1750394748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOZMA | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S.,R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1470 | ||||||||
| Address2: | |||||||||
| City: | PORT WASHINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110507470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166292456 | ||||||||
| FaxNumber: | 5166292027 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 PORT WASHINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | ROSLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115761353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166292456 | ||||||||
| FaxNumber: | 5166292027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 11/14/2008 | ||||||||
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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 | 133V00000X | 001327 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.