Healthcare Provider Details

I. General information

NPI: 1043839392
Provider Name (Legal Business Name): MEAGHAN OLIVIA COYNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

505 E 70TH ST FL 4
NEW YORK NY
10021-4872
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5506
  • Fax:
Mailing address:
  • Phone: 212-746-2900
  • Fax: 212-746-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number313152
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number313152
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: