Healthcare Provider Details

I. General information

NPI: 1669471371
Provider Name (Legal Business Name): COASTAL ORTHOPAEDICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 MAIN AVE SUITE 115
NORWALK CT
06851-1080
US

IV. Provider business mailing address

761 MAIN AVE SUITE 115
NORWALK CT
06851-1080
US

V. Phone/Fax

Practice location:
  • Phone: 203-845-2200
  • Fax: 203-847-1940
Mailing address:
  • Phone: 203-845-2200
  • Fax: 203-847-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD LYON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 203-845-2069