Provider Demographics
NPI:1013902931
Name:COGGIOLA, PETER ANGELO (MSN, NP)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:ANGELO
Last Name:COGGIOLA
Suffix:
Gender:M
Credentials:MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4470 JORDAN ROAD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14550
Mailing Address - Country:US
Mailing Address - Phone:614-484-8101
Mailing Address - Fax:505-468-9629
Practice Address - Street 1:39 DUNCAN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1017
Practice Address - Country:US
Practice Address - Phone:585-786-0190
Practice Address - Fax:585-786-0196
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3304121208800000X
NYF402728363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01273165Medicaid
NY161511795OtherNOVA
NY161511795OtherNORTH AMERICAN PREFERRED
NY060926000008OtherFIDELIS CARE NEW YORK
NY9512103OtherINDEPENDENT HEALTH
NYP00320181OtherRAILROAD MEDICARE
NY161511795OtherHUMANA
NY109448FZOtherPREFERRED CARE
NY000570031004OtherCOMMUNITY BLUE
NY7599612OtherGHI
NYP019330412OtherBLUE CHOICE
NY000570031004OtherCOMMUNITY BLUE
NY161511795OtherNOVA