Provider Demographics
NPI:1841283744
Name:KOZAR, ALBERT J (DO)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:J
Last Name:KOZAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ALBERT
Other - Middle Name:J
Other - Last Name:KOZAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:54 W AVON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3680
Mailing Address - Country:US
Mailing Address - Phone:860-675-0357
Mailing Address - Fax:860-675-0358
Practice Address - Street 1:54 W AVON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3680
Practice Address - Country:US
Practice Address - Phone:860-675-0357
Practice Address - Fax:860-675-0358
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040264204C00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1871799635OtherGROUP NPI
040264OtherSTATE CT LICENSE
OH34007170KOtherSTATE OH LICENSE
CT120000087Medicare ID - Type Unspecified
CT1871799635OtherGROUP NPI
OH34007170KOtherSTATE OH LICENSE