Provider Demographics
NPI:1063740157
Name:PELLIEN, ANGELINE COGGINS (BS, RPA, MS)
Entity type:Individual
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First Name:ANGELINE
Middle Name:COGGINS
Last Name:PELLIEN
Suffix:
Gender:F
Credentials:BS, RPA, MS
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3775 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3434
Mailing Address - Country:US
Mailing Address - Phone:716-712-0890
Mailing Address - Fax:716-712-0933
Practice Address - Street 1:3775 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3434
Practice Address - Country:US
Practice Address - Phone:716-712-0890
Practice Address - Fax:716-712-0933
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY001076-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical