MEDICARE: EMILY COYLE APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ01026600	NJ

General Provider Information

NPI Number	:	1174158299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY COYLE APN

Provider Business Mailing Address
First Line	:	216 E RIDGEWOOD AVE STE 3B
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3849
Country	:	US
Telephone Number	:	551-288-6543
Fax Number	:	551-212-3041

Provider Business Practice Location Address
First Line	:	216 E RIDGEWOOD AVE STE 3B
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3849
Country	:	US
Telephone Number	:	551-288-6543
Fax Number	:	551-212-3041

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2020
Last Update Date	:	09/26/2025

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