Provider Demographics
NPI:1871561571
Name:KOSOY, EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:KOSOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SCHWEINBERG DR
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1133
Mailing Address - Country:US
Mailing Address - Phone:973-627-7888
Mailing Address - Fax:973-627-7040
Practice Address - Street 1:704 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6468
Practice Address - Country:US
Practice Address - Phone:973-771-8601
Practice Address - Fax:973-228-3200
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228980207Q00000X
NJ25MA07609500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0004324Medicaid
NJH92358Medicare UPIN
NJ072464Medicare ID - Type Unspecified