Provider Demographics
NPI:1093746547
Name:KOSMORSKY MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:KOSMORSKY MEDICAL ASSOCIATES, LLC
Other - Org Name:NEWTOWN PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KOSMORSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-504-0414
Mailing Address - Street 1:23 CAMBRIDGE LANE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3326
Mailing Address - Country:US
Mailing Address - Phone:215-504-0414
Mailing Address - Fax:215-504-4002
Practice Address - Street 1:23 CAMBRIDGE LANE
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3326
Practice Address - Country:US
Practice Address - Phone:215-504-0414
Practice Address - Fax:215-504-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009215560022Medicaid
PA0009215560022Medicaid