Healthcare Provider Details

I. General information

NPI: 1467996207
Provider Name (Legal Business Name): JOHN COSGROVE ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST PRESBYTERIAN HOSPITAL, 11TH FLOOR- CENTER WING
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST PRESBYTERIAN HOSPITAL, 11TH FLOOR- CENTER WING
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 646-317-5162
  • Fax:
Mailing address:
  • Phone: 646-317-5162
  • Fax: 212-305-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number2000017672
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: