Basic Information
| Provider Information | |||||||||
| NPI: | 1154651503 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | COULIBALY | ||||||||
| FirstName: | NIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 506 LENOX AVE | ||||||||
| Address2: | DEPARTMENT OB/GYN, 4TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100371802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129394335 | ||||||||
| FaxNumber: | 2129394344 | ||||||||
| Practice Location | |||||||||
| Address1: | 506 LENOX AVE | ||||||||
| Address2: | DEPARTMENT OB/GYN, 4TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100371802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129394335 | ||||||||
| FaxNumber: | 2129394344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2010 | ||||||||
| LastUpdateDate: | 11/25/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 275090 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.