Provider Demographics
NPI:1093321184
Name:MATTHEW KOZMINSKI DO PLLC
Entity type:Organization
Organization Name:MATTHEW KOZMINSKI DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-330-5061
Mailing Address - Street 1:238 BEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:PA
Mailing Address - Zip Code:16052-3204
Mailing Address - Country:US
Mailing Address - Phone:814-330-5061
Mailing Address - Fax:
Practice Address - Street 1:215 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1765
Practice Address - Country:US
Practice Address - Phone:724-749-4118
Practice Address - Fax:724-202-0394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1649303108OtherINDIVIDUAL PROVIDER