Provider Demographics
NPI:1467085498
Name:KOSAKOWSKI, MACIEJ (DMD)
Entity type:Individual
Prefix:DR
First Name:MACIEJ
Middle Name:
Last Name:KOSAKOWSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:KOSAKOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:435 E 70TH ST APT 31A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 BRIDGETOWN PIKE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4326
Practice Address - Country:US
Practice Address - Phone:215-322-7810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0445371223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty