Organization
OFFICE BASED MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LETICIA COTTO (BILLING MANAGER)
(718) 416-4389
Entity
Organization
Contact information
Practice address
67 ROCKYWOOD RD, MANHASSET, NY 11030-2512
(718) 416-4389
(718) 416-3652
Mailing address
67 ROCKYWOOD RD, MANHASSET, NY 11030-2512
(718) 416-4389
(718) 416-3652
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
189533
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01599522
—
NY
Enumeration date
05/07/2008
Last updated
06/17/2009
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