Provider Demographics
NPI:1144669771
Name:ALICEA-COSME, CHRISTINA
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:ALICEA-COSME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 WYTHE AVE
Mailing Address - Street 2:APT.6E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-6852
Mailing Address - Country:US
Mailing Address - Phone:718-612-3208
Mailing Address - Fax:
Practice Address - Street 1:571 WYTHE AVE
Practice Address - Street 2:APT.6E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-6852
Practice Address - Country:US
Practice Address - Phone:718-612-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY844335174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist