Provider Demographics
NPI:1497942270
Name:COAST TO COAST HOSPITAL SURGEONS INC
Entity Type:Organization
Organization Name:COAST TO COAST HOSPITAL SURGEONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:POLHEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-237-6797
Mailing Address - Street 1:976 MCLEAN AVENUE
Mailing Address - Street 2:SUITE 387
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4105
Mailing Address - Country:US
Mailing Address - Phone:914-237-6797
Mailing Address - Fax:
Practice Address - Street 1:976 MCLEAN AVE
Practice Address - Street 2:SUITE 387
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-4105
Practice Address - Country:US
Practice Address - Phone:914-237-6797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700197Medicare PIN
FLAH324Medicare PIN
GAGRP7848Medicare PIN
TX0A4596Medicare PIN