Provider Demographics
NPI:1285257998
Name:KOSOR, JON JEFFREY
Entity type:Individual
Prefix:
First Name:JON
Middle Name:JEFFREY
Last Name:KOSOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 ROCKLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-1601
Mailing Address - Country:US
Mailing Address - Phone:260-239-1175
Mailing Address - Fax:412-851-3225
Practice Address - Street 1:100 BROUGHTON RD STE B
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2836
Practice Address - Country:US
Practice Address - Phone:412-851-3223
Practice Address - Fax:412-851-3225
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA46233601374U00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide