Provider Demographics
NPI:1467452060
Name:COTOS-MEJIA, DAVID NICOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NICOLAS
Last Name:COTOS-MEJIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 37TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-2510
Mailing Address - Country:US
Mailing Address - Phone:718-965-3738
Mailing Address - Fax:718-965-2423
Practice Address - Street 1:416 37TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-2510
Practice Address - Country:US
Practice Address - Phone:718-965-3738
Practice Address - Fax:718-965-2423
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2012-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
685191OtherEMPIRE BLUE SHIELD
NY01643172Medicaid
NY685191Medicare ID - Type Unspecified
NY01643172Medicaid