Provider Demographics
NPI:1952367369
Name:KOZINN, MARC J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:J
Last Name:KOZINN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8604 MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7463
Mailing Address - Country:US
Mailing Address - Phone:716-635-7600
Mailing Address - Fax:716-635-7603
Practice Address - Street 1:19 LIMESTONE DR
Practice Address - Street 2:SUITE 11
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7091
Practice Address - Country:US
Practice Address - Phone:716-635-7600
Practice Address - Fax:716-635-7603
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2014-03-26
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Provider Licenses
StateLicense IDTaxonomies
NY156801207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001041125Medicaid
NY001041125Medicaid