Provider Demographics
NPI:1659468627
Name:KOSAKOSKI, JOSEPH MICHAEL JR (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:KOSAKOSKI
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WATERFRONT ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-4133
Mailing Address - Country:US
Mailing Address - Phone:717-291-2185
Mailing Address - Fax:
Practice Address - Street 1:230 HARRISBURG AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2959
Practice Address - Country:US
Practice Address - Phone:717-509-1931
Practice Address - Fax:717-509-1934
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS4628L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA414656Medicare ID - Type Unspecified
PAD98713Medicare UPIN