Provider Demographics
NPI:1295798262
Name:KOCINSKI, MICHAEL S (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:KOCINSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 NEW JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD CREST
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-1216
Mailing Address - Country:US
Mailing Address - Phone:609-523-1331
Mailing Address - Fax:609-522-1516
Practice Address - Street 1:6410 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:WILDWOOD CREST
Practice Address - State:NJ
Practice Address - Zip Code:08260-1216
Practice Address - Country:US
Practice Address - Phone:609-523-1331
Practice Address - Fax:609-522-1516
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54675207Q00000X
PAOS 009951L207Q00000X
NJ25MB07045200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH58509Medicare UPIN