Provider Demographics
NPI:1902168529
Name:COZZOLINO, LEE MARIA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:MARIA
Last Name:COZZOLINO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:MARIA
Other - Last Name:FABIANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LEE COZZOLINO
Mailing Address - Street 1:158 GUILDFORD CT
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2212
Mailing Address - Country:US
Mailing Address - Phone:516-376-0315
Mailing Address - Fax:
Practice Address - Street 1:236 2ND AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2704
Practice Address - Country:US
Practice Address - Phone:212-683-8905
Practice Address - Fax:212-683-8906
Is Sole Proprietor?:No
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2222178174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist