NPIMap

Organization Active NPI

Coyle S Connolly DO PA

  • Dermatology Physician
  • Linwood, NJ
National Provider Identifier
1053367516
Registry record updated Dec 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
25MB06289800 Issued in 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
Last updated
Dec 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Coyle S Connolly, DONPI 1386601433
Title
President
Phone
(609) 926-8899

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 25MB06289800 NJ Primary

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 names 1

  • Connolly Dermatology Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Locations

890 W Bay Ave
Ste C
Barnegat, NJ 08005
Phone (609) 660-8002

8 Brick Plz
Brick, NJ 08723
Phone (973) 630-8947

220 Brighton Rd
Cape May Court House, NJ 08210

833 Lacey Rd
Ste F2
Forked River, NJ 08731

310 Chris Gaupp Dr
Ste 102
Galloway, NJ 08205
Phone (609) 652-9933

392 N White Horse Pike
Ste 3
Hammonton, NJ 08037

2106 New Rd
#1
Linwood, NJ 08221

2106 New Rd
Ste D1
Linwood, NJ 08221
Phone (609) 927-9545

2106 New Rd
Ste D4
Linwood, NJ 08221
Phone (609) 926-6474

108 Roosevelt Blvd
Marmora, NJ 08223

190 Route 70
Medford, NJ 08055

1103 W Sherman Ave
Bldg 2A
Vineland, NJ 08360
Phone (856) 692-9900

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

Practitioners & affiliated clinicians

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 47

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606867200000",
    "number": "1053367516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2099 NEW ALBANY RD",
            "city": "CINNAMINSON",
            "state": "NJ",
            "postal_code": "080773534",
            "telephone_number": "609-926-8899",
            "fax_number": "609-653-8713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2106 NEW RD",
            "address_2": "SUITE D4",
            "city": "LINWOOD",
            "state": "NJ",
            "postal_code": "082211046",
            "telephone_number": "609-926-8899",
            "fax_number": "609-926-6474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COYLE S CONNOLLY DO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A",
        "authorized_official_last_name": "CONNOLLY",
        "authorized_official_first_name": "COYLE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "609-926-8899",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NJ",
            "license": "25MB06289800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Connolly Dermatology",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Connolly Dermatology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Linwood, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.