Provider Demographics
NPI:1659331965
Name:COSICO, DANILO GONZALES (MD)
Entity Type:Individual
Prefix:DR
First Name:DANILO
Middle Name:GONZALES
Last Name:COSICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SARAH CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3731
Mailing Address - Country:US
Mailing Address - Phone:518-452-8708
Mailing Address - Fax:
Practice Address - Street 1:22 SARAH CT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3731
Practice Address - Country:US
Practice Address - Phone:518-452-8708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115589208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00632059Medicaid
NYRB7704Medicare PIN
NY00632059Medicaid
NYB77892Medicare UPIN