Provider Demographics
NPI:1457324295
Name:COHALL, ALWYN
Entity Type:Individual
Prefix:DR
First Name:ALWYN
Middle Name:
Last Name:COHALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 SPROUT BROOK RD
Mailing Address - Street 2:CORTLANDT MANOR,
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-7332
Mailing Address - Country:US
Mailing Address - Phone:914-739-4358
Mailing Address - Fax:
Practice Address - Street 1:COLOUMBIA UNIVERSITY DEPARTMENT PEDIATRICS
Practice Address - Street 2:3959 BROADWAY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-927-3214
Practice Address - Fax:212-544-1974
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153930208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG24891Medicare UPIN
NY38F561Medicare ID - Type Unspecified