Basic Information
| Provider Information | |||||||||
| NPI: | 1144807637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COORG | ||||||||
| FirstName: | SANTOSH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 ASPEN CIR | ||||||||
| Address2: | |||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088202831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087201916 | ||||||||
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| Practice Location | |||||||||
| Address1: | 833 CHESTNUT ST FL 1 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556776 | ||||||||
| FaxNumber: | 2159231089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2021 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.