Healthcare Provider Details

I. General information

NPI: 1881037901
Provider Name (Legal Business Name): RYAN MICHAEL COYLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 PACIFIC AVE 1ST FL STE 1511
ATLANTIC CITY NJ
08401
US

IV. Provider business mailing address

1925 PACIFIC AVE 1ST FL STE 1511
ATLANTIC CITY NJ
08401
US

V. Phone/Fax

Practice location:
  • Phone: 609-441-8165
  • Fax: 609-593-9850
Mailing address:
  • Phone: 609-441-8165
  • Fax: 609-593-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA10513000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number25MA10513000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: