Provider Demographics
NPI:1386601433
Name:CONNOLLY, COYLE S (DO PA)
Entity type:Individual
Prefix:DR
First Name:COYLE
Middle Name:S
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:DO PA
Other - Prefix:
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Mailing Address - Street 1:2099 NEW ALBANY RD
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3534
Mailing Address - Country:US
Mailing Address - Phone:609-926-8899
Mailing Address - Fax:856-772-1997
Practice Address - Street 1:2106 NEW RD STE D4
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1050
Practice Address - Country:US
Practice Address - Phone:609-926-8899
Practice Address - Fax:609-926-6474
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB06289800207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ875105P5LMedicare ID - Type Unspecified
NJG28081Medicare UPIN