Provider Demographics
NPI:1689257750
Name:KOZAK, TUNDE
Entity type:Individual
Prefix:
First Name:TUNDE
Middle Name:
Last Name:KOZAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 NE 3RD ST APT 6
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1770
Mailing Address - Country:US
Mailing Address - Phone:732-407-7327
Mailing Address - Fax:
Practice Address - Street 1:1300 NE 3RD ST APT 6
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1770
Practice Address - Country:US
Practice Address - Phone:732-407-7327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA68081225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist