Provider Demographics
NPI:1427949759
Name:ADRA MEDICAL PLLC
Entity type:Organization
Organization Name:ADRA MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-828-4545
Mailing Address - Street 1:1050 OLD NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5026
Mailing Address - Country:US
Mailing Address - Phone:631-828-4545
Mailing Address - Fax:631-209-5783
Practice Address - Street 1:1050 OLD NICHOLS RD
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5026
Practice Address - Country:US
Practice Address - Phone:631-828-4545
Practice Address - Fax:631-209-5783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty