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:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:516-810-6555
Mailing Address - Fax:516-665-4495
Practice Address - Street 1:243 LAKEVIEW AVE W
Practice Address - Street 2:
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718-1901
Practice Address - Country:US
Practice Address - Phone:631-810-6555
Practice Address - Fax:631-665-4495
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004012-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX21702Medicare ID - Type Unspecified