Basic Information
| Provider Information | |||||||||
| NPI: | 1265840953 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COFFEY | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15-98 208TH ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308810553 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4500 PARSONS BLVD | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113552205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186703000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2014 | ||||||||
| LastUpdateDate: | 08/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | AR3268198189 | RI | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.