Healthcare Provider Details

I. General information

NPI: 1033676366
Provider Name (Legal Business Name): JUDITH COFFEY COLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDITH RACHEL COFFEY NP

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W 125TH ST FL 2
NEW YORK NY
10027-3649
US

IV. Provider business mailing address

321 W 125TH ST FL 2
NEW YORK NY
10027-3649
US

V. Phone/Fax

Practice location:
  • Phone: 212-289-2378
  • Fax: 212-497-2640
Mailing address:
  • Phone: 212-289-2378
  • Fax: 212-497-2640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number309036
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: