Provider Demographics
NPI:1659753754
Name:KOZAK, MEGAN (RD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KOZAK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 4TH AVE APT D9
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2512
Mailing Address - Country:US
Mailing Address - Phone:646-467-2771
Mailing Address - Fax:
Practice Address - Street 1:7201 4TH AVE APT D9
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2512
Practice Address - Country:US
Practice Address - Phone:646-467-2771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007763-1133V00000X
NY026100-1172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered