Provider Demographics
NPI:1669973798
Name:COTTER, ADAM DAVID (PA - C)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:DAVID
Last Name:COTTER
Suffix:
Gender:M
Credentials:PA - C
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Mailing Address - Street 1:1357 N WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4811
Mailing Address - Country:US
Mailing Address - Phone:631-521-6763
Mailing Address - Fax:
Practice Address - Street 1:1175 MONTAUK HWY STE NO3
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4939
Practice Address - Country:US
Practice Address - Phone:631-500-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical