Provider Demographics
NPI:1780687814
Name:COLOSI, JOSEPH (FP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:COLOSI
Suffix:
Gender:M
Credentials:FP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4272
Mailing Address - Street 2:CAP MEDICAL LLC
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13442
Mailing Address - Country:US
Mailing Address - Phone:315-336-0759
Mailing Address - Fax:315-338-5407
Practice Address - Street 1:610 FRENCH RD
Practice Address - Street 2:CAP MEDICAL LLC
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413
Practice Address - Country:US
Practice Address - Phone:315-738-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190889207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E42877Medicare UPIN