Provider Demographics
NPI:1104836592
Name:COASTAL ORTHOPEDIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:COASTAL ORTHOPEDIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAUSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-787-0075
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-0516
Mailing Address - Country:US
Mailing Address - Phone:732-787-0075
Mailing Address - Fax:732-787-0178
Practice Address - Street 1:800 W MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2554
Practice Address - Country:US
Practice Address - Phone:732-787-0075
Practice Address - Fax:732-787-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03504900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE52206Medicare UPIN