Basic Information
| Provider Information | |||||||||
| NPI: | 1699943266 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR JOSEPH M COSCINO PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PREMIER FOOT & ANKLE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1S067 SUMMIT AVE | ||||||||
| Address2: | |||||||||
| City: | OAKBROOK TERRACE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601813978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302619500 | ||||||||
| FaxNumber: | 6302619504 | ||||||||
| Practice Location | |||||||||
| Address1: | 1S067 SUMMIT AVE | ||||||||
| Address2: | |||||||||
| City: | OAKBROOK TERRACE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601813978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302619500 | ||||||||
| FaxNumber: | 6302619504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2008 | ||||||||
| LastUpdateDate: | 10/05/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COSCINO | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6302619500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 016-004563 | IL | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 60010824 | 01 | IL | BC/BS | OTHER | 016004563 | 05 | IL | MEDICAID |