Basic Information
| Provider Information | |||||||||
| NPI: | 1629110465 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COASTAL SURGICAL ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3822 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | POINT PLEASANT BORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087422067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327014848 | ||||||||
| FaxNumber: | 7327011244 | ||||||||
| Practice Location | |||||||||
| Address1: | 3822 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | POINT PLEASANT BORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087422067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327014848 | ||||||||
| FaxNumber: | 7327011244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 06/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | PRIOLO | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7327014848 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.