Healthcare Provider Details

I. General information

NPI: 1861432791
Provider Name (Legal Business Name): STEPHEN COSENTINO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CYPRESS CREEK RD SUITE 203
FT LAUDERDALE FL
33334-3522
US

IV. Provider business mailing address

800 E CYPRESS CREEK RD SUITE 203
FT LAUDERDALE FL
33334-3522
US

V. Phone/Fax

Practice location:
  • Phone: 954-772-5556
  • Fax: 954-772-6254
Mailing address:
  • Phone: 954-772-5556
  • Fax: 954-772-6254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS 6794
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: