Provider Demographics
NPI:1467085498
Name:KOSAKOWSKI, MACIEJ (DMD)
Entity Type:Individual
Prefix:DR
First Name:MACIEJ
Middle Name:
Last Name:KOSAKOWSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:KOSAKOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:7 TALCOTT FOREST RD APT I
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:203-524-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program