Provider Demographics
NPI:1588698146
Name:COYNE, JAMES (MA, CCC/A)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:COYNE
Suffix:
Gender:M
Credentials:MA, CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NORTHERN BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5312
Mailing Address - Country:US
Mailing Address - Phone:516-482-0660
Mailing Address - Fax:516-482-9131
Practice Address - Street 1:1000 NORTHERN BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5312
Practice Address - Country:US
Practice Address - Phone:516-482-0660
Practice Address - Fax:516-482-9131
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002004174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY82M093Medicare ID - Type Unspecified