Provider Demographics
NPI:1013020551
Name:JAMES J KOSIK, DO, PC
Entity Type:Organization
Organization Name:JAMES J KOSIK, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSIK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:570-457-9299
Mailing Address - Street 1:824 MCALPINE ST
Mailing Address - Street 2:
Mailing Address - City:AVOCA
Mailing Address - State:PA
Mailing Address - Zip Code:18641-1140
Mailing Address - Country:US
Mailing Address - Phone:570-457-9299
Mailing Address - Fax:570-457-5014
Practice Address - Street 1:824 MCALPINE ST
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:PA
Practice Address - Zip Code:18641-1140
Practice Address - Country:US
Practice Address - Phone:570-457-9299
Practice Address - Fax:570-457-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-007465-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF 82396Medicare UPIN
PA104196Medicare PIN