Provider Demographics
NPI:1548891195
Name:KOSIEWSKA, ANNMARIE (PA)
Entity type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:
Last Name:KOSIEWSKA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 OCEAN AVE UNIT 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3576
Mailing Address - Country:US
Mailing Address - Phone:718-444-7774
Mailing Address - Fax:
Practice Address - Street 1:2409 OCEAN AVE UNIT 1F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3576
Practice Address - Country:US
Practice Address - Phone:718-444-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0269582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program