Healthcare Provider Details

I. General information

NPI: 1699893925
Provider Name (Legal Business Name): SHORELINE SURGICAL ASSOC. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SAYBROOK RD SUITE 110
MIDDLETOWN CT
06457
US

IV. Provider business mailing address

400 SAYBROOK RD SUITE 110
MIDDLETOWN CT
06457
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-9167
  • Fax: 860-347-1630
Mailing address:
  • Phone: 860-347-9167
  • Fax: 860-347-1630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH A COATTI
Title or Position: PRESIDENT
Credential: MD
Phone: 860-347-9167