Provider Demographics
NPI:1770654485
Name:COASTAL ANESTHESIA, P.C.
Entity Type:Organization
Organization Name:COASTAL ANESTHESIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODITIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-932-6000
Mailing Address - Street 1:2318 31ST ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2892
Mailing Address - Country:US
Mailing Address - Phone:718-932-6000
Mailing Address - Fax:718-932-3194
Practice Address - Street 1:2318 31ST ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2892
Practice Address - Country:US
Practice Address - Phone:718-932-6000
Practice Address - Fax:718-932-3194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEIN