Provider Demographics
NPI:1649355736
Name:EAST COAST ORTHOPAEDIC & SPORTS MEDICINE, LLC
Entity type:Organization
Organization Name:EAST COAST ORTHOPAEDIC & SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-748-2922
Mailing Address - Street 1:731 LACEY RD
Mailing Address - Street 2:SUITE G4
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-1364
Mailing Address - Country:US
Mailing Address - Phone:609-242-6999
Mailing Address - Fax:609-242-6922
Practice Address - Street 1:731 LACEY RD
Practice Address - Street 2:SUITE G4
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1364
Practice Address - Country:US
Practice Address - Phone:609-242-6999
Practice Address - Fax:609-242-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ101695Medicare ID - Type Unspecified