Provider Demographics
NPI:1568576908
Name:EAST COAST MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:EAST COAST MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:SHAUN
Authorized Official - Last Name:VINIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-391-1085
Mailing Address - Street 1:1500 NW 10TH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1312
Mailing Address - Country:US
Mailing Address - Phone:561-391-1085
Mailing Address - Fax:561-391-1449
Practice Address - Street 1:1500 NW 10TH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1312
Practice Address - Country:US
Practice Address - Phone:561-391-1085
Practice Address - Fax:561-391-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39479OtherBCBS
FL39479OtherBCBS