Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | MD458499 | PA |
Y | 2080P0203X | Pediatric Critical Care Doctor | MD458499 | PA |
NPI | 1043470016 |
---|---|
Provider Name | Dr. Benjamin Wesley Kozyak |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2008 |
Last Update Date | 15/02/2017 |