Basic Information
Provider Information
NPI: 1467407965
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COGGINS
FirstName: CANDACE
MiddleName: C.
NamePrefix: MS.
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 GUSTAVE L LEVY PL
Address2: BOX 1070
City: NEW YORK
State: NY
PostalCode: 100296500
CountryCode: US
TelephoneNumber: 2122412906
FaxNumber: 2128609737
Practice Location
Address1: 1 GUSTAVE L LEVY PL
Address2: 1070
City: NEW YORK
State: NY
PostalCode: 100296500
CountryCode: US
TelephoneNumber: 2122412906
FaxNumber: 2128609737
Other Information
ProviderEnumerationDate: 05/23/2006
LastUpdateDate: 01/18/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XF4001551NYN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363L00000X440028NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

ID Information
IDTypeStateIssuerDescription
44002801NYPALLIATIVE CARE NP LICENSOTHER
F400155101NYNYS LICENSEOTHER


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