Provider Demographics
NPI:1770837379
Name:KOZMINSKI, KEITH G (RRT/CRTT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:G
Last Name:KOZMINSKI
Suffix:
Gender:M
Credentials:RRT/CRTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 CAYUGA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1932
Mailing Address - Country:US
Mailing Address - Phone:716-465-0522
Mailing Address - Fax:
Practice Address - Street 1:666 CAYUGA CREEK RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1932
Practice Address - Country:US
Practice Address - Phone:716-465-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-04
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified