Provider Demographics
NPI:1902852064
Name:KOZAKOWSKI, EDWARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:KOZAKOWSKI
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 1:834 PLAZA PL
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-3853
Mailing Address - Country:US
Mailing Address - Phone:609-391-1419
Mailing Address - Fax:
Practice Address - Street 1:48 ANSLEY BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3058
Practice Address - Country:US
Practice Address - Phone:609-641-1077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03372300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56360Medicare UPIN