Healthcare Provider Details

I. General information

NPI: 1205108560
Provider Name (Legal Business Name): ROBIN MARY KOWALSKI COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 GREENPOINT AVE
SCHENECTADY NY
12303-4027
US

IV. Provider business mailing address

1912 GREENPOINT AVE
SCHENECTADY NY
12303-4027
US

V. Phone/Fax

Practice location:
  • Phone: 518-355-2748
  • Fax:
Mailing address:
  • Phone: 518-355-2748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number003971-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: