MEDICARE: COASTAL CLINICAL PATHOLOGY P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician		NJ

General Provider Information

NPI Number	:	1427057082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL CLINICAL PATHOLOGY P A

Provider Business Mailing Address
First Line	:	5401 HARDING HWY
Second Line	:
City	:	MAYS LANDING
State	:	NJ
Zip	:	08330-2243
Country	:	US
Telephone Number	:	609-926-9056
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 HARDING HWY
Second Line	:
City	:	MAYS LANDING
State	:	NJ
Zip	:	08330-2243
Country	:	US
Telephone Number	:	609-926-9056
Fax Number	:

Authorized Official
Title or Position	:	HEAD DOCTOR
Name	:	DR. ROBERT BEACH
Credential	:	M.D.
Telephone Number	:	609-926-9056

Provider Enumeration Date	:	07/17/2005
Last Update Date	:	07/21/2022

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