Provider Demographics
NPI:1851478663
Name:COYNE, ELLEN M (DC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:COYNE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:243 LAKEVIEW AVE W
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWATERS
Mailing Address - State:NY
Mailing Address - Zip Code:11718-1901
Mailing Address - Country:US
Mailing Address - Phone:631-665-4495
Mailing Address - Fax:631-665-4495
Practice Address - Street 1:123 WEST 79TH STREET
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-875-9780
Practice Address - Fax:212-875-0975
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYX004012-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX21702Medicare ID - Type Unspecified