Provider Demographics
NPI:1265482897
Name:KOSS, STEPHEN D (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:KOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:108 BILBY ROAD
Mailing Address - Street 2:STE 201
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840
Mailing Address - Country:US
Mailing Address - Phone:908-684-3005
Mailing Address - Fax:908-684-3301
Practice Address - Street 1:108 BILBY RD
Practice Address - Street 2:STE 201
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4174
Practice Address - Country:US
Practice Address - Phone:908-684-3005
Practice Address - Fax:908-684-3301
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-02-13
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06416800207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7165307Medicaid
540798Medicare ID - Type UnspecifiedGROUP #
NJ887260VAHMedicare PIN
NJ7165307Medicaid