Provider Demographics
NPI:1881661510
Name:KOSSEV, VILIANA D (MD)
Entity Type:Individual
Prefix:
First Name:VILIANA
Middle Name:D
Last Name:KOSSEV
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 1:235 RTE 71
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-2806
Mailing Address - Country:US
Mailing Address - Phone:732-223-4300
Mailing Address - Fax:732-223-5273
Practice Address - Street 1:235 RTE 71
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2806
Practice Address - Country:US
Practice Address - Phone:732-223-4300
Practice Address - Fax:732-223-5273
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07707200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029785Medicaid
NJH54514Medicare UPIN
NJ076235Medicare ID - Type Unspecified