Provider Demographics
NPI:1740207158
Name:COASTAL AUDIOLOGY LLC
Entity Type:Organization
Organization Name:COASTAL AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-795-5502
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:CEDAR BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08018-0175
Mailing Address - Country:US
Mailing Address - Phone:609-704-1857
Mailing Address - Fax:609-704-1859
Practice Address - Street 1:24 NAUTILUS DR
Practice Address - Street 2:SUITE 6
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2490
Practice Address - Country:US
Practice Address - Phone:609-978-9192
Practice Address - Fax:609-798-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YB00000800231H00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS55585Medicare UPIN
NJ080293Medicare PIN