Provider Demographics
NPI:1396876587
Name:KOSCIEWICZ, FRANCIS JR (CRNA)
Entity type:Individual
Prefix:
First Name:FRANCIS
Middle Name:
Last Name:KOSCIEWICZ
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 MACGREGOR LN
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-3200
Mailing Address - Country:US
Mailing Address - Phone:315-469-4380
Mailing Address - Fax:
Practice Address - Street 1:550 HARRISON ST
Practice Address - Street 2:SUITE 230
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3096
Practice Address - Country:US
Practice Address - Phone:315-472-4424
Practice Address - Fax:315-475-8056
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY398567367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA6122Medicare ID - Type Unspecified