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General NPI Number Information
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NPI Number | 1801217575
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Entity Type | Organization
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Legal Business Name | THOMAS G COYLE
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Dates
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Enumeration Date | 12/26/2013
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Last Update Date | 12/26/2013
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Provider Practice Location Address
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Address Line | 375 S END AVE APARTMENT 25 U
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City | NEW YORK
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State | NY
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Zip | 10280-1014
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Country | US
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Telephone | 917-566-2313
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Fax | 212-689-7010
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Provider Business Mailing Address
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Address Line | 375 SOUTH END AVENUE APARTMENT 25 U
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City | NEW YORK
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State | NY
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Zip | 10280
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Country | US
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Telephone | 917-566-2313
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Fax | 212-689-7010
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MR. THOMAS GERARD COYLE
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Credential |
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Telephone | 917-566-2313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number | LA - 666357
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License Number State | NY
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