Provider Demographics
NPI:1417997701
Name:COYLE, RALUCA (MD)
Entity Type:Individual
Prefix:DR
First Name:RALUCA
Middle Name:
Last Name:COYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2545
Mailing Address - Country:US
Mailing Address - Phone:973-680-0400
Mailing Address - Fax:973-680-0400
Practice Address - Street 1:733 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2545
Practice Address - Country:US
Practice Address - Phone:973-680-0400
Practice Address - Fax:973-680-0400
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA073751174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0019259Medicaid
NJG33984Medicare UPIN
NJ069738AHLMedicare ID - Type Unspecified