Provider Demographics
NPI:1407919772
Name:KOSLOW, LISA RACHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RACHEL
Last Name:KOSLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 OLD BETHPAGE RD
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-1240
Mailing Address - Country:US
Mailing Address - Phone:516-293-0666
Mailing Address - Fax:516-293-8218
Practice Address - Street 1:700 OLD BETHPAGE RD
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1240
Practice Address - Country:US
Practice Address - Phone:516-293-0666
Practice Address - Fax:516-293-8218
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY235268208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics