Provider Demographics
NPI:1013350701
Name:KOZAK, NONIE (OSC)
Entity Type:Individual
Prefix:MRS
First Name:NONIE
Middle Name:
Last Name:KOZAK
Suffix:
Gender:F
Credentials:OSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 MANHASSET ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-2403
Mailing Address - Country:US
Mailing Address - Phone:631-277-5984
Mailing Address - Fax:
Practice Address - Street 1:1227 MONTAUK HWY UNIT 2
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1492
Practice Address - Country:US
Practice Address - Phone:631-218-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator