Basic Information
| Provider Information | |||||||||
| NPI: | 1669458998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICOSMO | ||||||||
| FirstName: | BRUNO | ||||||||
| MiddleName: | FRANCESCO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 210 WESTCHESTER AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106042901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146813146 | ||||||||
| FaxNumber: | 9146826403 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 THEALL RD | ||||||||
| Address2: | |||||||||
| City: | RYE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105801404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9148488777 | ||||||||
| FaxNumber: | 9146826403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 10/16/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 031054 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 196360-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 015028810046 | 05 | NY | MEDICAID | 000342 | 01 | NY | CONNECTICARE | OTHER | 133884168 | 01 | NY | MULTIPLAN (PUL. ONLY) | OTHER | 133884168 | 01 | NY | UNITED HEALTH CARE | OTHER | 436L81/2 | 01 | NY | BLUE CROSS | OTHER | 50491 | 01 | NY | GHI HMO | OTHER | OD1657 | 01 | NY | HEALTH NET | OTHER | 559640 | 01 | NY | AETNA HMO | OTHER | 133884168 | 01 | NY | HIP | OTHER | WS1056 | 01 | NY | OXFORD | OTHER | 133884168 | 01 | NY | GHI PPO | OTHER | 436L81 | 01 | NY | EMPIRE STATE PLAN (NYS) | OTHER | 4566679 | 01 | NY | AETNA NON HMO | OTHER | 1338841668 | 01 | NY | POMCO | OTHER | 133884168 | 01 | NY | BEECH STREET | OTHER | 133884168 | 01 | NY | PHCS | OTHER | 1553731-009/007 | 01 | NY | CIGNA PCO/SPECIALTY | OTHER |