Healthcare Provider Details

I. General information

NPI: 1457077968
Provider Name (Legal Business Name): FRANCES NICOLE BONFIGLIO COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FRANCES NICOLE PORTILLO-LLORENS MAIDEN NAME

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CRYSTAL RUN RD STE 201
MIDDLETOWN NY
10941-7010
US

IV. Provider business mailing address

75 CRYSTAL RUN RD STE 201
MIDDLETOWN NY
10941-7010
US

V. Phone/Fax

Practice location:
  • Phone: 845-692-4391
  • Fax:
Mailing address:
  • Phone: 845-692-4391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TA09231300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number011179-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: