MEDICARE: DR. JOHN GREGORY COTTONE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	017050-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396887733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN GREGORY COTTONE PH.D.

Provider Business Mailing Address
First Line	:	1099 NORTH COUNTRY RD
Second Line	:	SUITE L
City	:	STONY BROOK
State	:	NY
Zip	:	11790-1999
Country	:	US
Telephone Number	:	631-941-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1099 NORTH COUNTRY RD
Second Line	:	SUITE L
City	:	STONY BROOK
State	:	NY
Zip	:	11790-1999
Country	:	US
Telephone Number	:	631-941-2211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	01/26/2012

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