Basic Information
| Provider Information | |||||||||
| NPI: | 1982619615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COTUGNO | ||||||||
| FirstName: | STEFFANI | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823700 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 939 ROUTE 146 STE 700 | ||||||||
| Address2: | |||||||||
| City: | CLIFTON PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120653662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183830891 | ||||||||
| FaxNumber: | 5183831662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 03/21/2019 | ||||||||
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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 | 207Q00000X | 197586 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000401506001 | 01 | NY | BSNENY | OTHER | 47327 | 01 | NY | GHI/HMO | OTHER | 200087 | 01 | NY | SENIOR WHOLE HEALTH | OTHER | 08310 | 01 | NY | MVP | OTHER | 692101 | 01 | NY | EMPIRE BC | OTHER | 5548679 | 01 | NY | AETNA | OTHER | 070216000043 | 01 | NY | FIDELIS | OTHER | 10000404 | 01 | NY | CDPHP | OTHER | 01668271 | 05 | NY | MEDICAID |