Healthcare Provider Details

I. General information

NPI: 1902739865
Provider Name (Legal Business Name): COSMO JOSEPH NYLANDER DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 PROVIDENCE RD
SECANE PA
19018-3502
US

IV. Provider business mailing address

1206 PROVIDENCE RD
SECANE PA
19018-3502
US

V. Phone/Fax

Practice location:
  • Phone: 267-586-3934
  • Fax:
Mailing address:
  • Phone: 267-586-3934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberSP027149
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: