MEDICARE: MRS. DAWN COBURN PA

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	363AM0700X	Medical Physician Assistant	0040651	NY

General Provider Information

NPI Number	:	1457342073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAWN COBURN PA

Provider Business Mailing Address
First Line	:	25931 148TH DR
Second Line	:
City	:	ROSEDALE
State	:	NY
Zip	:	11422-3001
Country	:	US
Telephone Number	:	718-276-4482
Fax Number	:	718-276-5083

Provider Business Practice Location Address
First Line	:	234-32 MERRICK BLVD
Second Line	:
City	:	ROSEDALE
State	:	NY
Zip	:	11422
Country	:	US
Telephone Number	:	718-376-4482
Fax Number	:	718-276-5083

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	06/17/2009

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