Provider Demographics
NPI:1548415326
Name:COSENTINO, ANDREA BETH
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:BETH
Last Name:COSENTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3225
Mailing Address - Country:US
Mailing Address - Phone:718-344-0850
Mailing Address - Fax:
Practice Address - Street 1:7420 COMMONWEALTH BLVD
Practice Address - Street 2:DISTRICT 75 ROOM 170
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1800
Practice Address - Country:US
Practice Address - Phone:718-776-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist