=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043511298
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNA P COULES P.A
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2010
-----------------------------------------------------
Last Update Date | 11/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 ROCKAWAY TPKE SUITE 1
-----------------------------------------------------
City | CEDARHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11516-1833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-239-1800
-----------------------------------------------------
Fax | 516-239-5553
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2499 FARMERS AVE
-----------------------------------------------------
City | BELLMORE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11710-3814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-809-5415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 004339
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------