Provider Demographics
NPI:1033676366
Name:COLE, JUDITH COFFEY (NP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:COFFEY
Last Name:COLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:RACHEL
Other - Last Name:COFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:290 MALCOLM X BLVD LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4991
Mailing Address - Country:US
Mailing Address - Phone:212-289-2378
Mailing Address - Fax:
Practice Address - Street 1:527 BAY RD STE 7
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1430
Practice Address - Country:US
Practice Address - Phone:212-585-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309036363LA2200X
NY421380363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health