Basic Information
| Provider Information | |||||||||
| NPI: | 1669452199 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COASTAL CARDIOVASCULAR CONSULTANTS, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 459 JACK MARTIN BLVD | ||||||||
| Address2: | STE 4 | ||||||||
| City: | BRICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087247724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324586200 | ||||||||
| FaxNumber: | 7324589464 | ||||||||
| Practice Location | |||||||||
| Address1: | 459 JACK MARTIN BLVD | ||||||||
| Address2: | STE 4 | ||||||||
| City: | BRICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087247724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324586200 | ||||||||
| FaxNumber: | 7324589464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 06/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | ESCANDON | ||||||||
| AuthorizedOfficialFirstName: | PEDRO | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7324586200 | ||||||||
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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 | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.