Provider Demographics
NPI:1972607000
Name:COSSARI, ALFRED JOSEPH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:JOSEPH
Last Name:COSSARI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:311 BARNUM AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-928-6400
Mailing Address - Fax:631-928-2353
Practice Address - Street 1:311 BARNUM AVENUE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-928-6400
Practice Address - Fax:631-928-2353
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119075-1207WX0110X
NY119075207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY222615Medicaid
558761Medicare ID - Type Unspecified
NY222615Medicaid