Healthcare Provider Details

I. General information

NPI: 1629494216
Provider Name (Legal Business Name): DANIALLE R. COYNE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIALLE R. CALAUSTRO NP

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E 102ND ST FL 4
NEW YORK NY
10029-5204
US

IV. Provider business mailing address

PO BOX 28082
NEW YORK NY
10087-8082
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8552
  • Fax: 212-426-0349
Mailing address:
  • Phone: 212-731-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF307184
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: