Provider Demographics
NPI:1821039926
Name:COSENTINO, PHILLIP J (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:J
Last Name:COSENTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:78 TODT HILL RD
Mailing Address - Street 2:STE 206
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-816-0034
Mailing Address - Fax:718-727-3191
Practice Address - Street 1:78 TODT HILL RD
Practice Address - Street 2:STE 206
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-816-0034
Practice Address - Fax:718-727-3191
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY161111207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW6L821OtherGROUP MEDICARE ID
NYW6L821OtherGROUP MEDICARE ID
A60658Medicare UPIN