Provider Demographics
NPI:1265527311
Name:COFFIN, NINA RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:RUTH
Last Name:COFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:185 CENTRAL AVE
Mailing Address - Street 2:SUITE 603
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-3332
Mailing Address - Country:US
Mailing Address - Phone:973-676-3918
Mailing Address - Fax:973-676-5383
Practice Address - Street 1:185 CENTRAL AVE
Practice Address - Street 2:SUITE 603
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3332
Practice Address - Country:US
Practice Address - Phone:973-676-3918
Practice Address - Fax:973-676-5383
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03966700207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3583309Medicaid
NJC56597Medicare UPIN
NJ3583309Medicaid