Provider Demographics
NPI:1285223933
Name:GOLD COAST MEDICAL WELLNESS, PLLC
Entity Type:Organization
Organization Name:GOLD COAST MEDICAL WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-547-4100
Mailing Address - Street 1:700 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4264
Mailing Address - Country:US
Mailing Address - Phone:631-547-4100
Mailing Address - Fax:631-923-2907
Practice Address - Street 1:700 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4264
Practice Address - Country:US
Practice Address - Phone:631-547-4100
Practice Address - Fax:631-923-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty