Provider Demographics
NPI:1881022937
Name:COSMELLO, DOMINICK GEORGE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DOMINICK
Middle Name:GEORGE
Last Name:COSMELLO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 WAGNER RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18834-8159
Mailing Address - Country:US
Mailing Address - Phone:570-840-2735
Mailing Address - Fax:
Practice Address - Street 1:344 WAGNER RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18834-8159
Practice Address - Country:US
Practice Address - Phone:570-840-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY616117-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered