Provider Demographics
NPI:1710451984
Name:COSME, JUAN SAMUEL
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:SAMUEL
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 1:3065 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5141
Mailing Address - Country:US
Mailing Address - Phone:347-218-1730
Mailing Address - Fax:
Practice Address - Street 1:968 CAULDWELL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-6804
Practice Address - Country:US
Practice Address - Phone:347-218-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker