Individual provider Active NPI

Elizabeth Kosmetatos, MD

  • Pediatrics Physician
  • Brick, NJ
National Provider Identifier
1386725281
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
25MA08170500 Issued in NJ
Practice address
1301 Route 70
Brick, NJ 08724-2670
Phone
(732) 892-8700
Fax
(732) 892-2048
NPI assigned
Oct 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 25MA08170500 NJ Primary

Addresses

Primary practice location

1301 Route 70
Brick, NJ 08724-2670

Mailing address

1301 Route 70
Brick, NJ 08724-2670
Phone (732) 892-8700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160229002481 NJ Practitioner - Pediatric Medicine 0648575605 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA08170500NJMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocare, LLC Pediatrics CurrentSince Dec 15, 2015 Accepting new patients
Advocare , LLC CurrentSince Dec 15, 2015 Accepting new patients

Locations

132 Grove St
Ste A
Haddonfield, NJ 08033
Phone (856) 354-2211

402 Lippincott Dr
Marlton, NJ 08053
Phone (410) 763-8787

Interoperability endpoints

  • Direct secure messaging: liz@pak.pcc-direct.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386725281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 ROUTE 70",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087242670",
            "telephone_number": "732-892-8700",
            "fax_number": "732-892-2048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 ROUTE 70",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087242670",
            "telephone_number": "732-892-8700",
            "fax_number": "732-892-2048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSMETATOS",
        "first_name": "ELIZABETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA08170500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brick, NJ

Sources for this page

Verify at the official NPI Registry.