Provider Demographics
NPI:1154651503
Name:COULIBALY, NIA (MD)
Entity Type:Individual
Prefix:
First Name:NIA
Middle Name:
Last Name:COULIBALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 LENOX AVE
Mailing Address - Street 2:DEPARTMENT OB/GYN, 4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1802
Mailing Address - Country:US
Mailing Address - Phone:212-939-4335
Mailing Address - Fax:212-939-4344
Practice Address - Street 1:506 LENOX AVE
Practice Address - Street 2:DEPARTMENT OB/GYN, 4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-4335
Practice Address - Fax:212-939-4344
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275090207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology