Provider Demographics
NPI:1396887733
Name:COTTONE, JOHN GREGORY (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GREGORY
Last Name:COTTONE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 NORTH COUNTRY RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1999
Mailing Address - Country:US
Mailing Address - Phone:631-941-2211
Mailing Address - Fax:
Practice Address - Street 1:1099 NORTH COUNTRY RD
Practice Address - Street 2:SUITE L
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1999
Practice Address - Country:US
Practice Address - Phone:631-941-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017050-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02857523Medicaid