Provider Demographics
NPI:1992841837
Name:EF COSENTINO POD PHYSICIAN & SURGEON INC
Entity Type:Organization
Organization Name:EF COSENTINO POD PHYSICIAN & SURGEON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:COSENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-545-4993
Mailing Address - Street 1:603 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1748
Mailing Address - Country:US
Mailing Address - Phone:330-545-4993
Mailing Address - Fax:330-545-5200
Practice Address - Street 1:603 N STATE ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1748
Practice Address - Country:US
Practice Address - Phone:330-545-4993
Practice Address - Fax:330-545-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002089213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0654788Medicaid
OH1323530001Medicare NSC
OH9918071Medicare PIN