Individual
JAY R KOSTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1207 CHESTNUT ST FL 3, PHILADELPHIA, PA 19107-4131
(267) 725-0252
(215) 732-1046
Mailing address
1233 LOCUST ST FL 3, PHILADELPHIA, PA 19107-5400
(215) 985-4448
(215) 985-1145
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
MD035184E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001087179
—
PA
01
—
761315
MEDICARE
PA
Enumeration date
06/22/2006
Last updated
03/17/2018
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