Healthcare Provider Details

I. General information

NPI: 1659542652
Provider Name (Legal Business Name): CHARLES F COYLE JR DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N WINTON RD
ROCHESTER NY
14610
US

IV. Provider business mailing address

555 N WINTON RD
ROCHESTER NY
14610
US

V. Phone/Fax

Practice location:
  • Phone: 585-654-8910
  • Fax: 585-654-8922
Mailing address:
  • Phone: 585-654-8910
  • Fax: 585-654-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN002374
License Number StateNY

VIII. Authorized Official

Name: CHARLES F COYLE JR.
Title or Position: OWNER PODIATRIST
Credential: DPM
Phone: 585-654-8910