Provider Demographics
NPI:1518151950
Name:NOGUERA COUGHLAN, LUISA E (MD)
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:E
Last Name:NOGUERA COUGHLAN
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 1:1037 MAIN ST
Mailing Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2913
Mailing Address - Country:US
Mailing Address - Phone:914-734-8800
Mailing Address - Fax:914-964-7307
Practice Address - Street 1:2 PARK AVE
Practice Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-3402
Practice Address - Country:US
Practice Address - Phone:914-964-7862
Practice Address - Fax:914-964-7307
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264950207R00000X, 261QP2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03285605Medicaid
NYA400078076Medicare PIN