Provider Demographics
NPI:1316219470
Name:COASTAL SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:COASTAL SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-280-7855
Mailing Address - Street 1:3700 ROUTE 33
Mailing Address - Street 2:SUITE LL-01
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-3206
Mailing Address - Country:US
Mailing Address - Phone:732-280-7855
Mailing Address - Fax:
Practice Address - Street 1:3700 ROUTE 33
Practice Address - Street 2:SUITE LL-01
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-3206
Practice Address - Country:US
Practice Address - Phone:732-280-7855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical