Provider Demographics
NPI:1265502033
Name:CNY ASTHMA & ALLERGY CONSULTANTS PC
Entity Type:Organization
Organization Name:CNY ASTHMA & ALLERGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:COSACHOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:315-252-9562
Mailing Address - Street 1:37 WEST GARDEN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021
Mailing Address - Country:US
Mailing Address - Phone:315-252-9562
Mailing Address - Fax:315-255-3872
Practice Address - Street 1:37 WEST GARDEN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021
Practice Address - Country:US
Practice Address - Phone:315-252-9562
Practice Address - Fax:315-255-3872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02225345Medicaid
NY46981OtherMVP
NYG0185031060OtherBLUE CHOICE
NYG0185031060OtherBLUE CHOICE
NY46981OtherMVP