Healthcare Provider Details

I. General information

NPI: 1417361122
Provider Name (Legal Business Name): MARIA C. COE, MSRD,CDN,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 ROOSEVELT AVE
CORONA NY
11368-2331
US

IV. Provider business mailing address

3135 31ST ST UNIT 303
LONG ISLAND CITY NY
11106-2591
US

V. Phone/Fax

Practice location:
  • Phone: 718-898-1386
  • Fax: 718-898-1903
Mailing address:
  • Phone: 718-545-1632
  • Fax: 718-898-1093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number003935
License Number StateNY

VIII. Authorized Official

Name: MS. MARIA CORAZON COE
Title or Position: PRESIDENT
Credential: R.D.
Phone: 718-545-1632