Provider Demographics
NPI:1073620647
Name:COSENZA, JOHN JOSEPH (APRN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:COSENZA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:175 FERRY RD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1406
Mailing Address - Country:US
Mailing Address - Phone:860-388-9313
Mailing Address - Fax:860-437-3601
Practice Address - Street 1:VA CLINIC/USCGA
Practice Address - Street 2:15 MOHEGAN AVE
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-437-3611
Practice Address - Fax:860-437-1801
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CTCT001144363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health