Provider Demographics
NPI:1144262890
Name:WESLEY P KOZINN MD PC
Entity type:Organization
Organization Name:WESLEY P KOZINN MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEEPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-253-7818
Mailing Address - Street 1:2061 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3953
Mailing Address - Country:US
Mailing Address - Phone:610-253-7818
Mailing Address - Fax:610-253-1764
Practice Address - Street 1:2061 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3953
Practice Address - Country:US
Practice Address - Phone:610-253-7818
Practice Address - Fax:610-253-1764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020649E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA469374OtherAETNA
PA0006057700009Medicaid
PA093187ZA3DMedicare PIN
NJ147642ZC2VMedicare PIN
PA749741Medicare UPIN
PA0006057700009Medicaid
PAB33527Medicare UPIN
PA025420Medicare ID - Type UnspecifiedMEDICARE
PA469374OtherAETNA
PAI36333Medicare UPIN