Provider Demographics
NPI:1861496481
Name:KOZICKY, OREST JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:OREST
Middle Name:JOHN
Last Name:KOZICKY
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:P.O. BOX 998
Mailing Address - Street 2:ATTN: SJR MEDICAL, PC.
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-0998
Mailing Address - Country:US
Mailing Address - Phone:914-966-9787
Mailing Address - Fax:914-966-9793
Practice Address - Street 1:1088 NORTH BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-207-0004
Practice Address - Fax:914-965-0107
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151151207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY92D59EZ911Medicare PIN
B20171Medicare UPIN