Provider Demographics
NPI:1598951121
Name:COSGROVE, THERESA MARGARET (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARGARET
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 CLIFTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-365-2273
Mailing Address - Fax:973-473-1122
Practice Address - Street 1:1005 CLIFTON AVENUE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-365-2273
Practice Address - Fax:973-473-1122
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2526111N00000X
AZ4876111N00000X
WA2613111N00000X
PADC004685L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
520633Medicare PIN
T87628Medicare UPIN