Provider Demographics
NPI:1992028286
Name:COSENTINO, LAWRENCE THOMAS (MS RPH)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:THOMAS
Last Name:COSENTINO
Suffix:
Gender:M
Credentials:MS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 AMPERE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1004
Mailing Address - Country:US
Mailing Address - Phone:718-931-1604
Mailing Address - Fax:
Practice Address - Street 1:3212 AMPERE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1004
Practice Address - Country:US
Practice Address - Phone:718-931-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028647183500000X, 1835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY913Medicaid