Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 040264 | CT |
N | 207QS0010X | Family Doctor - Sports Medicine | 040264 | CT |
NPI | 1841283744 |
---|---|
Provider Name | Dr. Albert J Kozar |
First Address | Avon, CT 06001-3680 |
Second Address | Avon, CT 06001-3680 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 11/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040264 | STATE CT LICENSE (01) | |
1871799635 | GROUP NPI (01) | CT |
34007170K | STATE OH LICENSE (01) | OH |
H33775 | (02) | CT |