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General NPI Number Information
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NPI Number | 1477544096
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Entity Type | Individual
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Provider Name | EMERTH LANCE COBURN MD
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 21401 110TH AVE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429-1906
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Country | US
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Telephone | 929-615-6447
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Fax | 718-276-4783
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Provider Business Mailing Address
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Address Line | 214-01 110TH AVENUE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429
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Country | US
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Telephone | 718-276-4482
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Fax | 718-276-4783
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 198832
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 198832
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License Number State | NY
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