Provider Demographics
NPI:1659390193
Name:KOSSOW, LYNNE BECKER (MD)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:BECKER
Last Name:KOSSOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 ALEXANDER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6345
Mailing Address - Country:US
Mailing Address - Phone:609-655-3800
Mailing Address - Fax:609-655-5203
Practice Address - Street 1:731 ALEXANDER RD STE 201
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6345
Practice Address - Country:US
Practice Address - Phone:609-655-3800
Practice Address - Fax:866-912-7741
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05857200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5484006Medicaid
NJ671405Medicare ID - Type Unspecified
NJE85351Medicare UPIN