Provider Demographics
NPI:1710249230
Name:COSA, MICHELE (MASTERS SPECIAL ED)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:COSA
Suffix:
Gender:F
Credentials:MASTERS SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MCARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1925
Mailing Address - Country:US
Mailing Address - Phone:917-747-2360
Mailing Address - Fax:
Practice Address - Street 1:30 MCARTHUR AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1925
Practice Address - Country:US
Practice Address - Phone:917-747-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY829225174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist