Provider Demographics
NPI:1477859098
Name:OSKIE PEDIATRICS
Entity Type:Organization
Organization Name:OSKIE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-378-6171
Mailing Address - Street 1:555 KNOWLES DR STE 219
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1551
Mailing Address - Country:US
Mailing Address - Phone:408-378-6171
Mailing Address - Fax:408-378-0721
Practice Address - Street 1:555 KNOWLES DR STE 219
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1551
Practice Address - Country:US
Practice Address - Phone:408-378-6171
Practice Address - Fax:408-378-0721
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEWIS A. OSOFSKY, M,D,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-28
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77790208000000X
CAG47908208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF49033Medicare UPIN