Provider Demographics
NPI:1881142446
Name:KOSITS, KRISTEN R (MPS)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:R
Last Name:KOSITS
Suffix:
Gender:F
Credentials:MPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DAVENPORT AVE
Mailing Address - Street 2:APARTMENT 1E
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3444
Mailing Address - Country:US
Mailing Address - Phone:914-384-1600
Mailing Address - Fax:
Practice Address - Street 1:15 DAVENPORT AVE
Practice Address - Street 2:APARTMENT 1E
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-3444
Practice Address - Country:US
Practice Address - Phone:914-384-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYFQ88681JMedicaid