Provider Demographics
NPI:1629020227
Name:KOZAK, CYRIL (MD)
Entity Type:Individual
Prefix:DR
First Name:CYRIL
Middle Name:
Last Name:KOZAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-0725
Mailing Address - Country:US
Mailing Address - Phone:518-895-2000
Mailing Address - Fax:518-895-2624
Practice Address - Street 1:1 COOLEY HTS
Practice Address - Street 2:
Practice Address - City:DELANSON
Practice Address - State:NY
Practice Address - Zip Code:12053-2442
Practice Address - Country:US
Practice Address - Phone:518-895-2000
Practice Address - Fax:518-895-2624
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184223207Q00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01345197Medicaid
NYF39655Medicare UPIN
NY01345197Medicaid