Provider Demographics
NPI:1033145917
Name:FERRARI, COSIMO JOHN (MD)
Entity Type:Individual
Prefix:
First Name:COSIMO
Middle Name:JOHN
Last Name:FERRARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1251
Mailing Address - Country:US
Mailing Address - Phone:518-483-2578
Mailing Address - Fax:518-483-7266
Practice Address - Street 1:134 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1251
Practice Address - Country:US
Practice Address - Phone:518-483-2578
Practice Address - Fax:518-483-7266
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191957174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01461090Medicaid
NYF75021Medicare UPIN
NY54876BMedicare ID - Type Unspecified