Provider Demographics
NPI:1114099496
Name:COGNATO, JOHN C (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:COGNATO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-476-1792
Practice Address - Street 1:505 STATE ROUTE 281
Practice Address - Street 2:
Practice Address - City:TULLY
Practice Address - State:NY
Practice Address - Zip Code:13159-2494
Practice Address - Country:US
Practice Address - Phone:315-696-2400
Practice Address - Fax:315-696-2486
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00342913Medicare PIN
NYRA4247Medicare PIN
NYP39064Medicare UPIN