Individual
KOSSI ACOLITSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-2089
Mailing address
1075 GERARD AVE APT 108, BRONX, NY 10452-8864
(718) 410-2082
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
014720-1
NY
Other
Enumeration date
05/31/2011
Last updated
05/31/2011
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