Provider Demographics
NPI:1689604597
Name:KOSANN, MEREDITH KLEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:KLEIN
Last Name:KOSANN
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 1:150 PURCHASE ST
Mailing Address - Street 2:SUITE 12F
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2141
Mailing Address - Country:US
Mailing Address - Phone:914-908-3376
Mailing Address - Fax:
Practice Address - Street 1:150 PURCHASE ST
Practice Address - Street 2:SUITE 12F
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2141
Practice Address - Country:US
Practice Address - Phone:914-908-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217761207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH94828Medicare UPIN
NYH94828Medicare UPIN