Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1857 | NJ |
NPI | 1003892415 |
---|---|
Provider Name | Dr. Elliot Koziel |
First Address | Fort Lee, NJ 07024-2039 |
Second Address | Fort Lee, NJ 07024-2039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 19/11/2008 |