Provider Demographics
NPI:1841717808
Name:COASTAL PEDIATRIC ORTHOPEDICS
Entity type:Organization
Organization Name:COASTAL PEDIATRIC ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-403-3395
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-0359
Mailing Address - Country:US
Mailing Address - Phone:732-403-3395
Mailing Address - Fax:
Practice Address - Street 1:833 LACEY RD STE 2
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1200
Practice Address - Country:US
Practice Address - Phone:732-403-3395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1457593261OtherNPI