Healthcare Provider Details

I. General information

NPI: 1861278699
Provider Name (Legal Business Name): DARIUS BERTOLINO COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DUNNING RD
MIDDLETOWN NY
10940-2243
US

IV. Provider business mailing address

116 CHEECHUNK RD
GOSHEN NY
10924-6801
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-0801
  • Fax:
Mailing address:
  • Phone: 845-775-6340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number010889-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: