Provider Demographics
NPI:1801217575
Name:THOMAS G COYLE
Entity Type:Organization
Organization Name:THOMAS G COYLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-566-2313
Mailing Address - Street 1:375 SOUTH END AVENUE
Mailing Address - Street 2:APARTMENT 25 U
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280
Mailing Address - Country:US
Mailing Address - Phone:917-566-2313
Mailing Address - Fax:212-689-7010
Practice Address - Street 1:375 S END AVE
Practice Address - Street 2:APARTMENT 25 U
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1014
Practice Address - Country:US
Practice Address - Phone:917-566-2313
Practice Address - Fax:212-689-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLA - 666357251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYLA - 666357OtherLIFE HEALTH ACCIDENT LICENSE