Healthcare Provider Details

I. General information

NPI: 1417250135
Provider Name (Legal Business Name): ALFRED J. COSSARI, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 BARNUM AVE
PORT JEFFERSON NY
11777-1682
US

IV. Provider business mailing address

31 BARNUM AVENUE
PORT JEFFERSON NY
11777
US

V. Phone/Fax

Practice location:
  • Phone: 631-928-6400
  • Fax: 631-928-2353
Mailing address:
  • Phone: 631-928-6400
  • Fax: 631-928-2353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number119075
License Number StateNY

VIII. Authorized Official

Name: DR. ALFRED J COSSARI
Title or Position: PRESIDENT
Credential: MD
Phone: 631-928-6400