Provider Demographics
NPI:1417091356
Name:COTTROL, CHERYL HENRIETTA (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:HENRIETTA
Last Name:COTTROL
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 1:347 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3173
Mailing Address - Country:US
Mailing Address - Phone:212-369-2395
Mailing Address - Fax:866-529-5039
Practice Address - Street 1:347 W 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3173
Practice Address - Country:US
Practice Address - Phone:888-384-5554
Practice Address - Fax:866-529-5039
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT331772084P0800X
NY1615692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01000206Medicaid
A64374Medicare UPIN
NYA400152131Medicare PIN