Healthcare Provider Details

I. General information

NPI: 1972607000
Provider Name (Legal Business Name): ALFRED JOSEPH COSSARI JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 BARNUM AVENUE
PORT JEFFERSON NY
11777
US

IV. Provider business mailing address

311 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 TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number119075-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number119075
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: