Provider Demographics
NPI:1144276023
Name:KOSSOW, JEFFREY HARRIS (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HARRIS
Last Name:KOSSOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 FIRESIDE LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3418
Mailing Address - Country:US
Mailing Address - Phone:856-429-0458
Mailing Address - Fax:
Practice Address - Street 1:414 FIRESIDE LN
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3418
Practice Address - Country:US
Practice Address - Phone:856-429-0458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03057400208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7196202Medicaid
NJ894049Medicare ID - Type UnspecifiedMEDICARE NUMBER
NJD06851Medicare UPIN