Healthcare Provider Details

I. General information

NPI: 1386601433
Provider Name (Legal Business Name): COYLE S CONNOLLY D.O. PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 NEW RD STE D4
LINWOOD NJ
08221-1050
US

IV. Provider business mailing address

2099 NEW ALBANY RD
CINNAMINSON NJ
08077-3534
US

V. Phone/Fax

Practice location:
  • Phone: 609-926-8899
  • Fax: 609-926-6474
Mailing address:
  • Phone: 609-926-8899
  • Fax: 856-772-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MB06289800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: