MEDICARE: STEPHEN COSENTINO D.O.

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	OS 6794	FL

General Provider Information

NPI Number	:	1861432791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN COSENTINO D.O.

Provider Business Mailing Address
First Line	:	800 E CYPRESS CREEK RD
Second Line	:	SUITE 203
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33334-3522
Country	:	US
Telephone Number	:	954-772-5556
Fax Number	:	954-772-6254

Provider Business Practice Location Address
First Line	:	800 E CYPRESS CREEK RD
Second Line	:	SUITE 203
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33334-3522
Country	:	US
Telephone Number	:	954-772-5556
Fax Number	:	954-772-6254

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/08/2007

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