Provider Demographics
NPI:1356740708
Name:MCELLIGOTT, OISIN (COTA)
Entity type:Individual
Prefix:
First Name:OISIN
Middle Name:
Last Name:MCELLIGOTT
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 AVIS CT
Mailing Address - Street 2:
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913-1006
Mailing Address - Country:US
Mailing Address - Phone:845-653-1603
Mailing Address - Fax:
Practice Address - Street 1:4 AVIS CT
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1006
Practice Address - Country:US
Practice Address - Phone:845-653-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY64008470172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker