Coyle S Connolly DO PA
Organization Active NPI Dermatology Physician · Linwood, NJ
NPI 1053367516 · NPPES record last updated Dec 2, 2020
Key facts
- NPI
- 1053367516
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- 25MB06289800 (NJ)
- Legal business name
- COYLE S CONNOLLY DO PA
- Practice address
- 2106 New Rd
Suite D4
Linwood, NJ 08221-1046 - Phone
- (609) 926-8899
- Fax
- (609) 926-6474
- NPI assigned
- May 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Coyle S Connolly, DO
- Title
- President
- Phone
- (609) 926-8899
Practitioners 47
-
Coyle S Connolly, D.O. PA
-
Lisa Altman, APRN, FNP-BC
-
Eileen Aversa, NP
-
Elizabeth Jane Belk, APN
-
Brianna Domenica Bevilaque, MS, APRN, FNP-C
-
Devin Kathleen Bove, FNP
-
Elisa Conway, APN
-
Alyssa Dallicardillo, APN-C
-
Peter Davis, PA-C
-
Agata E Draper, APN
-
Jody A Maffei, FNP
-
Andriy Pavlenko, MD
-
Deborah Marie Pontoriero, ARNP
-
Jennifer Lee Sibiga, RN, MS, APN,C
-
Priya Thakker, M.D.
-
Naoana Victor, APN
-
Amanda Elizabeth Brennan, CRNP
-
Vincent Frank Accurso, PHYSICIAN ASSISTANT
-
Jacqueline Kalis Bohanko, PA-C
-
Lauren Cincotta, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NJ, PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040422001026 | NJ | Part B Supplier - Clinic/Group Practice | 2961498118 |
Receives reassigned benefits from 42 practitioners Practice locations: Manahawkin, NJ; Manchester, NJ; Marlton, NJ; Marmora, NJ; Medford, NJ; Toms River, NJ; Turnersville, NJ; Vineland, NJ… |
| O20200908000404 | PA | Part B Supplier - Clinic/Group Practice | 2961498118 |
Receives reassigned benefits from 3 practitioners Practice locations: Philadelphia, PA |
National Provider Directory
Locations
890 W Bay Ave
Ste C
Barnegat, NJ 08005
Phone (609) 660-8002
220 Brighton Rd
Cape May Court House, NJ 08210
2099 New Albany Rd
Cinnaminson, NJ 08077
Phone (856) 829-5545
833 Lacey Rd
Ste F2
Forked River, NJ 08731
392 N White Horse Pike
Ste 3
Hammonton, NJ 08037
101 Crawfords Corner Rd
Ste 1116A
Holmdel, NJ 07733
2106 New Rd
#1
Linwood, NJ 08221
2106 New Rd
Ste D1
Linwood, NJ 08221
Phone (609) 653-3075
2106 New Rd
Ste D4
Linwood, NJ 08221
Phone (609) 926-6474
108 Roosevelt Blvd
Marmora, NJ 08223
190 Route 70
Medford, NJ 08055
2 Kings Hwy E
Middletown, NJ 07748
Phone (732) 957-0707
1667 E Landis Ave
Bldg C
Vineland, NJ 08361
Phone (800) 732-2940
1103 W Sherman Ave
Unit A
Vineland, NJ 08360
1667 E Landis Ave
Unit 2
Vineland, NJ 08361
Phone (800) 732-2940
200 Route 73
Ste B
Voorhees, NJ 08043
2101 State Route 34
Ste H
Wall Township, NJ 07719
Phone (732) 282-1500
108 Lacey Rd
Ste 38A
Whiting, NJ 08759
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | 25MB06289800 | NJ | Yes |
Addresses
Primary practice location
2106 New Rd
Suite D4
Linwood, NJ 08221-1046
Mailing address
2099 New Albany Rd
Cinnaminson, NJ 08077-3534
Phone (609) 926-8899
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DE5501 | Other | NJ | MEDICARE RAILROAD |
Other names
- Connolly Dermatology
Other providers in Linwood, NJ
- Iniah Corbitt
- Matthew Michael Corbo
- Rosa M Cortes
- Shane P Courtney
- Frederick A Coville
- CPL (Linwood) LLC
- CPL (Linwood) LLC
- John A Cristini
- Kate-Lyn Crooks
- Cummins Counseling LLC
All providers in Linwood, NJ · Dermatology Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.