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Organization

AOTA

Active
Other names
COTA
Organization subpart
No

Provider details

NPI number
Authorized official
MS. VICKI DEROSS COTA (COTA)
(845) 492-6752
Entity
Organization

Contact information

Practice address
27 LAKE ST, MONROE, NY 10950-3521
(845) 492-6752
Mailing address
PO BOX 1394, GREENWOOD LAKE, NY 10925-1394
(845) 492-6752

Taxonomy

Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
004814-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0048141
COTA
NY
Enumeration date
09/02/2015
Last updated
09/02/2015
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