Provider Demographics
NPI:1235584616
Name:KOZIN, LARA (DPM)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:KOZIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-4635
Mailing Address - Country:US
Mailing Address - Phone:908-232-3346
Mailing Address - Fax:908-232-6920
Practice Address - Street 1:2265 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-4635
Practice Address - Country:US
Practice Address - Phone:908-232-3346
Practice Address - Fax:908-232-6920
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00348300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery