Healthcare Provider Details

I. General information

NPI: 1861024044
Provider Name (Legal Business Name): SIOBHAN IRENE CRONIN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 RAZ AVE
NEW WINDSOR NY
12553-4705
US

IV. Provider business mailing address

930 RAZ AVE
NEW WINDSOR NY
12553-4705
US

V. Phone/Fax

Practice location:
  • Phone: 845-564-1855
  • Fax:
Mailing address:
  • Phone: 845-564-1855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number010426-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: