Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 040748 | NY |
Y | 213EG0000X | General Practice | 040748 | NY |
NPI | 1003907452 |
---|---|
Provider Name | Dr. Anthony Peter Kossa |
First Address | Central Square, NY 13036-3500 |
Second Address | Central Square, NY 13036-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |