Provider Demographics
NPI:1033325253
Name:DICOSIMO, GERALDINE MARY (MS, RN, CS)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:MARY
Last Name:DICOSIMO
Suffix:
Gender:F
Credentials:MS, RN, CS
Other - Prefix:
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Mailing Address - Street 1:8415 HOBNAIL RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9332
Mailing Address - Country:US
Mailing Address - Phone:315-682-2622
Mailing Address - Fax:
Practice Address - Street 1:8112 CAZENOVIA ROAD
Practice Address - Street 2:SEVEN PINES OFFICE BLDG. ONE, SUITE 3
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104
Practice Address - Country:US
Practice Address - Phone:315-682-0726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300617-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health