Basic Information
| Provider Information | |||||||||
| NPI: | 1780686022 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOZOVATSKIY | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 GUTHRIE SQ | ||||||||
| Address2: | |||||||||
| City: | SAYRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 188401625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708885858 | ||||||||
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| Practice Location | |||||||||
| Address1: | 175 DENISON PARKWAY EAST | ||||||||
| Address2: | OPERATING ROOM | ||||||||
| City: | CORNING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6079377278 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 06/24/2011 | ||||||||
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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 | 207L00000X | 215326 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 174400000X | 215326 | NY | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 02059098 | 05 | NY | MEDICAID | CC8362 | 01 | NY | RR NY MEDICARE GROUP | OTHER | 1015730390001 | 05 | PA | MEDICAID |