Provider Demographics
NPI:1750336038
Name:COIRA, DIEGO L (MD)
Entity type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:L
Last Name:COIRA
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 1:9 POST RD STE M2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-1619
Mailing Address - Country:US
Mailing Address - Phone:201-904-2230
Mailing Address - Fax:201-904-2232
Practice Address - Street 1:9 POST RD STE M2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-1619
Practice Address - Country:US
Practice Address - Phone:201-904-2230
Practice Address - Fax:201-904-2232
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA629412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG40584Medicare UPIN
NJ044534Medicare ID - Type Unspecified