1699943266 NPI number — DR JOSEPH M COSCINO PC

Table of content: (NPI 1699943266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699943266 NPI number — DR JOSEPH M COSCINO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR JOSEPH M COSCINO PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PREMIER FOOT & ANKLE CENTER
Provider Other Organization Name Type Code:
3
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:
1699943266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1S067 SUMMIT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKBROOK TERRACE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60181-3978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-261-9500
Provider Business Mailing Address Fax Number:
630-261-9504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1S067 SUMMIT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKBROOK TERRACE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60181-3978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-261-9500
Provider Business Practice Location Address Fax Number:
630-261-9504
Provider Enumeration Date:
02/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COSCINO
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
630-261-9500

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  016-004563 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 60010824 . This is a "BC/BS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 016004563 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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