Provider Demographics
NPI:1295712891
Name:KOSOFSKY, ERIC MYLES (DPM)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MYLES
Last Name:KOSOFSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 ASYLUM AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2416
Mailing Address - Country:US
Mailing Address - Phone:860-523-8026
Mailing Address - Fax:860-523-7622
Practice Address - Street 1:999 ASYLUM AVE STE 111
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2416
Practice Address - Country:US
Practice Address - Phone:860-523-8026
Practice Address - Fax:860-523-7622
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000468213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0190960002OtherCIGNA
CT030000468CT04OtherANTHEM BLUE CROSS
0744660001OtherHEALTH NOW OF NEW YORK
0533188OtherAETNA
CT060468OtherCONNECTICARE
HAS384OtherORTHONET/OXFORD
061280198003OtherALLIED HEALTH GROUP
CT004162476Medicaid
061280198OtherUNITED HEALTHCARE
0P0501OtherHEALTHNET
480007333OtherRAILROAD MEDICARE
C14746OtherRAILROAD MEDICARE
HAS384OtherORTHONET/OXFORD
0P0501OtherHEALTHNET
CT030000468CT04OtherANTHEM BLUE CROSS
C14746OtherRAILROAD MEDICARE