Healthcare Provider Details

I. General information

NPI: 1386508216
Provider Name (Legal Business Name): CONNOR R COTTRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 E 78TH ST APT 5B
NEW YORK NY
10075-2267
US

IV. Provider business mailing address

306 E 78TH ST APT 5B
NEW YORK NY
10075-2267
US

V. Phone/Fax

Practice location:
  • Phone: 585-944-0957
  • Fax:
Mailing address:
  • Phone: 585-944-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number732864-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: