Provider Demographics
NPI:1013473032
Name:KOSLOWE, SHOSHANA ROYZA
Entity Type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:ROYZA
Last Name:KOSLOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 HIGHGATE TER
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3921
Mailing Address - Country:US
Mailing Address - Phone:201-960-7021
Mailing Address - Fax:
Practice Address - Street 1:131 HIGHGATE TER
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3921
Practice Address - Country:US
Practice Address - Phone:201-960-7021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program