Provider Demographics
NPI:1235321340
Name:COASTAL OBSTETRICS & GYNECOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:COASTAL OBSTETRICS & GYNECOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-652-6600
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-0386
Mailing Address - Country:US
Mailing Address - Phone:609-652-6600
Mailing Address - Fax:609-652-1267
Practice Address - Street 1:72 W JIM LEEDS RD
Practice Address - Street 2:SUITE 2500 STOCKTON MEDICAL BUILDING
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-0836
Practice Address - Country:US
Practice Address - Phone:609-652-6600
Practice Address - Fax:609-652-1267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA029589261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ418108Medicare PIN