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General NPI Number Information
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NPI Number | 1669973798
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Entity Type | Individual
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Provider Name | ADAM DAVID COTTER PA - C
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Gender | Male
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 02/23/2018
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Provider Practice Location Address
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Address Line | 1175 MONTAUK HWY STE NO3
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City | WEST ISLIP
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State | NY
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Zip | 11795-4939
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Country | US
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Telephone | 631-500-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 1357 N WINDSOR AVE
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City | BAY SHORE
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State | NY
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Zip | 11706-4811
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Country | US
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Telephone | 631-521-6763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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