Provider Demographics
NPI:1508602897
Name:COASTAL MEDICAL CARE LLC
Entity type:Organization
Organization Name:COASTAL MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:609-703-9596
Mailing Address - Street 1:293 US STATE ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223
Mailing Address - Country:US
Mailing Address - Phone:609-265-1500
Mailing Address - Fax:
Practice Address - Street 1:293 US STATE ROUTE 9
Practice Address - Street 2:
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223
Practice Address - Country:US
Practice Address - Phone:609-265-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty