Provider Demographics
NPI:1821090200
Name:KOZIKOWSKI, GRZEGORZ (MD)
Entity Type:Individual
Prefix:
First Name:GRZEGORZ
Middle Name:
Last Name:KOZIKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14222 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2319
Mailing Address - Country:US
Mailing Address - Phone:718-208-3244
Mailing Address - Fax:
Practice Address - Street 1:146 NORMAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-3385
Practice Address - Country:US
Practice Address - Phone:718-349-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222249207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02420299Medicaid
NY207AM1Medicare ID - Type Unspecified
NY02420299Medicaid