Provider Demographics
NPI:1083156038
Name:KOSNIK, STEPHANIE (MSSPED;SBL)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:KOSNIK
Suffix:
Gender:F
Credentials:MSSPED;SBL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60A DEVON LOOP
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5961
Mailing Address - Country:US
Mailing Address - Phone:917-816-8478
Mailing Address - Fax:
Practice Address - Street 1:60A DEVON LOOP
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5961
Practice Address - Country:US
Practice Address - Phone:917-816-8478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY423625101174400000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Yes174400000XOther Service ProvidersSpecialist