Provider Demographics
NPI:1376138933
Name:COTO COLES, ISIS M I
Entity Type:Individual
Prefix:MRS
First Name:ISIS
Middle Name:M
Last Name:COTO COLES
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1322
Mailing Address - Country:US
Mailing Address - Phone:973-437-6024
Mailing Address - Fax:
Practice Address - Street 1:75 MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1322
Practice Address - Country:US
Practice Address - Phone:973-437-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00647100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist