Healthcare Provider Details

I. General information

NPI: 1225978042
Provider Name (Legal Business Name): MS. ZENAIDA COSME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S WASHINGTON AVE STE 1000
SCRANTON PA
18505-3805
US

IV. Provider business mailing address

404 N BLAKELY ST
DUNMORE PA
18512-1934
US

V. Phone/Fax

Practice location:
  • Phone: 570-904-3792
  • Fax:
Mailing address:
  • Phone: 570-468-7715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number21127
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: