Provider Demographics
NPI:1417983453
Name:COYNE, TIMOTHY PATRICK (ATC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:COYNE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FAIRBANKS PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4337
Mailing Address - Country:US
Mailing Address - Phone:609-777-9299
Mailing Address - Fax:609-777-9299
Practice Address - Street 1:425 S MAIN ST
Practice Address - Street 2:HOPEWELL VALLEY REGIONAL SCHOOL DISTRICT
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2716
Practice Address - Country:US
Practice Address - Phone:609-737-4000
Practice Address - Fax:609-737-2947
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000411002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer