1750520599 NPI number — MR. ROBERT JOSEPH COYNE SR. LISW, LADAC

Table of content: JAYME S. MONROE (NPI 1518477041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750520599 NPI number — MR. ROBERT JOSEPH COYNE SR. LISW, LADAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COYNE
Provider First Name:
ROBERT
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
LISW, LADAC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COYNE
Provider Other First Name:
BOBBY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LISW, LADAC, CCFC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1750520599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2164 43RD ST
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
LOS ALAMOS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87544-1745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-661-7555
Provider Business Mailing Address Fax Number:
505-663-0100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 EASTGATE DR
Provider Second Line Business Practice Location Address:
STE 212 H
Provider Business Practice Location Address City Name:
LOS ALAMOS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87544-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-661-9700
Provider Business Practice Location Address Fax Number:
505-663-0100
Provider Enumeration Date:
02/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  4758 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: X-06325 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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