Basic Information
| Provider Information | |||||||||
| NPI: | 1063740157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PELLIEN | ||||||||
| FirstName: | ANGELINE | ||||||||
| MiddleName: | COGGINS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | B.S., R.P.A., M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3775 SENECA ST | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142243434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7167120890 | ||||||||
| FaxNumber: | 7167120933 | ||||||||
| Practice Location | |||||||||
| Address1: | 3775 SENECA ST | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142243434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7167120890 | ||||||||
| FaxNumber: | 7167120933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2009 | ||||||||
| LastUpdateDate: | 12/01/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 001076-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.