Basic Information
| Provider Information | |||||||||
| NPI: | 1932105236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOSC | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 MCBRIDE AVENUE | ||||||||
| Address2: | |||||||||
| City: | WOODLAND PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738121400 | ||||||||
| FaxNumber: | 9138121404 | ||||||||
| Practice Location | |||||||||
| Address1: | 1130 MCBRIDE AVENUE | ||||||||
| Address2: | |||||||||
| City: | WOODLAND PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738121400 | ||||||||
| FaxNumber: | 9138121404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 04/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 25MA04388300 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 1790803 | 05 | NJ | MEDICAID |