Provider Demographics
NPI:1558909812
Name:GEORGE A KOZMINSKI PHYSICIAN PC
Entity Type:Organization
Organization Name:GEORGE A KOZMINSKI PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOZMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-507-4751
Mailing Address - Street 1:1 OXFORD XING STE 1
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-3200
Mailing Address - Country:US
Mailing Address - Phone:315-507-4751
Mailing Address - Fax:315-765-6056
Practice Address - Street 1:1 OXFORD XING STE 1
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-3200
Practice Address - Country:US
Practice Address - Phone:315-507-4751
Practice Address - Fax:315-765-6056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty