Provider Demographics
NPI:1376370254
Name:ZOSIASHVILI, KOBA (SOLE PROPRIETOR)
Entity type:Individual
Prefix:
First Name:KOBA
Middle Name:
Last Name:ZOSIASHVILI
Suffix:
Gender:M
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 82ND ST APT 6H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2276
Mailing Address - Country:US
Mailing Address - Phone:347-971-2873
Mailing Address - Fax:201-907-1180
Practice Address - Street 1:1850 82ND ST APT 6H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2276
Practice Address - Country:US
Practice Address - Phone:347-971-2873
Practice Address - Fax:201-907-1180
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor