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General NPI Number Information
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NPI Number | 1124217195
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Entity Type | Organization
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Legal Business Name | JOHN G. COTTONE, PSYCHOLOGIST, PLLC
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 1099 N COUNTRY RD SUITE L
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City | STONY BROOK
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State | NY
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Zip | 11790-1924
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Country | US
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Telephone | 631-941-2210
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Fax | 631-941-2210
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Provider Business Mailing Address
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Address Line | 1099 N COUNTRY RD SUITE L
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City | STONY BROOK
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State | NY
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Zip | 11790-1924
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Country | US
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Telephone | 631-941-2210
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Fax | 631-941-2210
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN GREGORY COTTONE
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Credential | PH.D.
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Telephone | 631-941-2210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 017050-1
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License Number State | NY
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