Provider Demographics
NPI:1649437385
Name:KOZICH, JEANINE MASINGTON (MD)
Entity type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:MASINGTON
Last Name:KOZICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:33 DALE DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1603
Mailing Address - Country:US
Mailing Address - Phone:973-377-2861
Mailing Address - Fax:
Practice Address - Street 1:574 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1001
Practice Address - Country:US
Practice Address - Phone:908-518-3743
Practice Address - Fax:908-228-3621
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255548208000000X
NJ25MA09274100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics