Provider Demographics
NPI:1235263914
Name:KOSOFF, BOBB ROGER
Entity Type:Individual
Prefix:
First Name:BOBB
Middle Name:ROGER
Last Name:KOSOFF
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:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-0845
Mailing Address - Country:US
Mailing Address - Phone:530-824-1270
Mailing Address - Fax:530-824-3640
Practice Address - Street 1:23445 NEVA AVENUE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-9111
Practice Address - Country:US
Practice Address - Phone:530-824-1270
Practice Address - Fax:530-824-3640
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant