Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 004589 | NY |
NPI | 1003945858 |
---|---|
Provider Name | Dr. Michael Cocilovo |
First Address | Lincoln Park, NJ 07035-1858 |
Second Address | New City, NY 10956-3040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 10/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T53119 | (02) | NY |