1548251903 NPI number — DR. CONSTANCE A COZZA MD

Table of content: DR. CONSTANCE A COZZA MD (NPI 1548251903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548251903 NPI number — DR. CONSTANCE A COZZA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COZZA
Provider First Name:
CONSTANCE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548251903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2405 GENESEE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UTICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13501-6214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-798-9788
Provider Business Mailing Address Fax Number:
315-798-9766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2405 GENESEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UTICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13501-6214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-798-9788
Provider Business Practice Location Address Fax Number:
315-798-9766
Provider Enumeration Date:
11/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  222904 1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 050081858 . This is a "PALMETTO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10062293 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 207045400 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00931237 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060504000012 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2138895 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02194250 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 361178 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11315791 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".




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