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NPI Code Detail

MEDICARE: CORAL PSYCHIATRY

MEDICARE: CORAL PSYCHIATRY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1134991144
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORAL PSYCHIATRY
Provider Business Mailing Address
First Line : 595 5TH AVE
Second Line :
City : TROY
State : NY
Zip : 12182-2501
Country : US
Telephone Number : 518-414-5421
Fax Number :
Provider Business Practice Location Address
First Line : 595 5TH AVE
Second Line :
City : TROY
State : NY
Zip : 12182-2501
Country : US
Telephone Number : 518-414-5421
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. JENNIFER OKWEREKWU
Credential : MD
Telephone Number : 518-414-5421
Provider Enumeration Date : 10/23/2023
Last Update Date : 10/23/2023

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Directions to “CORAL PSYCHIATRY ” Practice Location

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