Provider Demographics
NPI:1235603994
Name:COYNE, JACQUELINE (MS, ATC, PES)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:COYNE
Suffix:
Gender:F
Credentials:MS, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HOMESTEAD ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3207
Mailing Address - Country:US
Mailing Address - Phone:518-598-8852
Mailing Address - Fax:
Practice Address - Street 1:12 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1004
Practice Address - Country:US
Practice Address - Phone:518-452-9809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer