Provider Demographics
NPI:1548773922
Name:COIRA INSTITUTE PA
Entity type:Organization
Organization Name:COIRA INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:L
Authorized Official - Last Name:COIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-347-1447
Mailing Address - Street 1:9 POST RD STE M2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-1619
Mailing Address - Country:US
Mailing Address - Phone:201-904-2230
Mailing Address - Fax:201-904-2232
Practice Address - Street 1:9 POST RD STE M2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-1619
Practice Address - Country:US
Practice Address - Phone:201-904-2230
Practice Address - Fax:201-904-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA629412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPENDINGMedicaid
NJ1750336038OtherPENDING