Healthcare Provider Details

I. General information

NPI: 1962490821
Provider Name (Legal Business Name): JOSEPH P. COYNE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E 87TH ST APT 6A
NEW YORK NY
10128-0549
US

IV. Provider business mailing address

12 E 87TH ST APT 6A
NEW YORK NY
10128-0549
US

V. Phone/Fax

Practice location:
  • Phone: 917-650-7261
  • Fax:
Mailing address:
  • Phone: 917-650-7261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA1004646
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: