Provider Demographics
NPI:1134241367
Name:ALICE V. COGHILL, M.D.
Entity type:Organization
Organization Name:ALICE V. COGHILL, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:V
Authorized Official - Last Name:COGHILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-244-4520
Mailing Address - Street 1:450 FASHION AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10123-0101
Mailing Address - Country:US
Mailing Address - Phone:212-244-4520
Mailing Address - Fax:
Practice Address - Street 1:450 FASHION AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10123-0101
Practice Address - Country:US
Practice Address - Phone:212-244-4520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150251261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00938945Medicaid
NY00938945Medicaid
NYF44409Medicare UPIN