Provider Demographics
NPI:1245254531
Name:KOSOSKY, CHARLES S (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:S
Last Name:KOSOSKY
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 1:2 CAPITAL WAY STE 456
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2521
Mailing Address - Country:US
Mailing Address - Phone:609-537-7300
Mailing Address - Fax:
Practice Address - Street 1:2 CAPITAL WAY STE 456
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2521
Practice Address - Country:US
Practice Address - Phone:609-537-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA319782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
130025823OtherRR MEDICARE
NJ1168107OtherHORIZON NJ HEALTH
NJ1467471OtherCIGNA
NJ1694405Medicaid
NJ223431049OtherDEVON
NJ2K6034OtherHEALTHNET
PA66243OtherBLUE SHIELD
PA75872000OtherPA BLUE SHIELD HMO
NJ066243OtherAETNA PPO
NJP2739065OtherOXFORD
NJ0075872000OtherKEYSTONE
NJ223431049NOtherHORIZON BLUE SHIELD
NJ2941455OtherAETNA HMO
NJ433274000OtherINDEPENDENT BCBS
NJ1168107OtherHORIZON NJ HEALTH
C52896Medicare UPIN