Provider Demographics
NPI:1932105236
Name:KOSC, GARY J (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:KOSC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1130 MCBRIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424
Mailing Address - Country:US
Mailing Address - Phone:973-812-1400
Mailing Address - Fax:913-812-1404
Practice Address - Street 1:1130 MCBRIDE AVENUE
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424
Practice Address - Country:US
Practice Address - Phone:973-812-1400
Practice Address - Fax:913-812-1404
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04388300207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1790803Medicaid
NJKO184660Medicare PIN
NJ110032994Medicare PIN
NJ1790803Medicaid