Provider Demographics
NPI:1235197013
Name:CROSS, COQUILLA DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:COQUILLA
Middle Name:DEBORAH
Last Name:CROSS
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 1:5 S GOODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-3705
Mailing Address - Country:US
Mailing Address - Phone:914-941-1805
Mailing Address - Fax:
Practice Address - Street 1:2094 ALBANY POST ROAD, MAIL CODE116A
Practice Address - Street 2:HUDSON VALLEY HEALTH CARE SYSTEM
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548
Practice Address - Country:US
Practice Address - Phone:914-737-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1511212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01587562Medicaid
NYE15289Medicare UPIN
NY399BK1Medicare PIN