=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922333848
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDDY COELLO PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2009
-----------------------------------------------------
Last Update Date | 12/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1915 CENTRAL PARK AVE # 25
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10710-2949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-961-3437
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 WESTCHESTER AVE
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10604-2901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-682-6440
-----------------------------------------------------
Fax | 914-682-6441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------