Healthcare Provider Details

I. General information

NPI: 1144807637
Provider Name (Legal Business Name): SANTOSH COORG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

372 CENTRAL PARK W APT 20A
NEW YORK NY
10025-8213
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-4000
  • Fax:
Mailing address:
  • Phone: 908-720-1916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number336039-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: