Healthcare Provider Details

I. General information

NPI: 1821894767
Provider Name (Legal Business Name): BELLA VIRGINIA COAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PORT WASHINGTON BLVD
ROSLYN NY
11576-1347
US

IV. Provider business mailing address

9 ANITA DR
SAYVILLE NY
11782-2801
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-6000
  • Fax:
Mailing address:
  • Phone: 631-375-3858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9122166
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number033375
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number033375
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: