Provider Demographics
NPI:1659843035
Name:COSME, CESAR A
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:A
Last Name:COSME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 TOMPKINS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-7170
Mailing Address - Country:US
Mailing Address - Phone:917-577-1338
Mailing Address - Fax:718-789-4900
Practice Address - Street 1:175 TOMPKINS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-7170
Practice Address - Country:US
Practice Address - Phone:917-577-1338
Practice Address - Fax:718-789-4900
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB01479343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04198656Medicaid