Provider Demographics
NPI:1174520589
Name:KOSIERACKI, EILEEN KATHERINE (DO)
Entity type:Individual
Prefix:MISS
First Name:EILEEN
Middle Name:KATHERINE
Last Name:KOSIERACKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 LONG BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-9310
Mailing Address - Country:US
Mailing Address - Phone:585-589-6247
Mailing Address - Fax:585-589-6351
Practice Address - Street 1:3916 LONG BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-9310
Practice Address - Country:US
Practice Address - Phone:585-589-6247
Practice Address - Fax:585-589-6351
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184108-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5900220OtherGHI
NY010184108OtherBC/BS ROCHESTER BLUE CHOI
NY0103805OtherINDEPENDENT HEALTH
NY00010093901OtherUNIVERA
NY5745356OtherAETNA
NYMD134POtherPREFERRED CARE
NY01248562Medicaid
NY000511199002OtherCOMMUNITY BLUE/ BC/BS BUF
NY5745356OtherAETNA
NY01248562Medicaid