Provider Demographics
NPI:1659542652
Name:CHARLES F COYLE JR DPM
Entity Type:Organization
Organization Name:CHARLES F COYLE JR DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:585-654-8910
Mailing Address - Street 1:555 N WINTON RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610
Mailing Address - Country:US
Mailing Address - Phone:585-654-8910
Mailing Address - Fax:585-654-8922
Practice Address - Street 1:555 N WINTON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610
Practice Address - Country:US
Practice Address - Phone:585-654-8910
Practice Address - Fax:585-654-8922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002374213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00418204Medicaid
NY00418204Medicaid
NYAA0137Medicare PIN