Provider Demographics
NPI:1134505589
Name:KASOZI, ALEXANDER MATHIAS
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:MATHIAS
Last Name:KASOZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 AFFINITY LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2471
Mailing Address - Country:US
Mailing Address - Phone:845-309-4011
Mailing Address - Fax:
Practice Address - Street 1:5570 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5477
Practice Address - Country:US
Practice Address - Phone:888-317-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010017-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant